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November 2013

The voice of London's Medical Students/

RAG season kicks off

Barts leads the way >> page 4

Polio resurgence

Outbreak hits Syria >> page 7

Healthcare for Migrants

Should they be charged? >> page 10

Still Life

ICSM get acting >> page 18

An End to Cambridge Transfer Students Peter Woodward-Court Making the transition from preclinical to clinical medicine brings with it many changes, but uniquely for London medics we see the addition of a body of students from Cambridge and Oxford, as they finish their degree in preclinical medical sciences and embark on their clinical careers. This process has taken place for a number of years, but it has recently been announced that Cambridge intend to stop all transfer students coming to London from 2017. Cambridge’s Clinical School was founded relatively recently, in 1976, and in the past has not had the capacity to accommodate all the students from its well-established undergraduate preclinical course. Thus, a number of students transfer and come, traditionally, to the London universities. Over the past four decades, Cambridge’s clinical school has been gradually expanding and they now intend to increase its capacity to the point where they can manage their entire preclinical cohort. The Medical Student has spoken to a number of senior staff from both universities to gain perspective on this issue. Cambridge describes the “anomaly” of transferring from Cambridge’s preclinical course to a different clinical education as “no longer fit for purpose from an educational perspective.” Over the past decade, Cambridge has been put under pressure from external stakeholders such as the GMC, Department of Health and NHS Employers to meet “more precise requirements” which Cambridge claims are difficult to achieve in a divided curriculum where 40% of students leave at the end of year 3. Indeed, Cambridge describes the process of transferring students as “severely hindering innovation,

since any change [we wish to make] would require coordination with the clinical and preclinical courses in [the] other medical schools.” Cambridge argues that having a full sixyear programme will provide the university with exciting opportunities to innovate educational themes with a currently underused teaching capacity, and emphasising the interdependence of core and clinical sciences and their importance for future clinical practice. London’s view was more blunt: “It’s nothing more than money.” The Medical Student was told, “Medical students attract money from the government and part of that money underpins the hospital.” The idea that Cambridge is making the decision to improve the educative experience was dismissed as “nonsense”: “Medicine is best in London, and it’s driven by the hospitals. The biggest hospitals have the most complicated patients, have the best doctors, have the best training environment.” We were informed that UCL partners have 6.3 million patients (10% of the country’s population) as a captive group. For Cambridge, we received an estimate of 300,000 patients from our London source, and 4.8 million from our Cambridge source. “Cambridge’s motive is ‘there’s nothing more than money driving this’, it’s nothing to do with the student experience.” “The question to ask is, does Cambridge have the capacity to train [the extra students]? I think they will struggle. I think the quality of placements would not be the quality of the placements they’d have in London”. Another source told us: “There is a question of capacity for students at Cambridge. It implies from their statement that students will stay in Addenbrookes. There isn’t the capacity in... [cont’n on page 2]

£16k of Debt and Rising for First Years

Chris Smith

A recent BMA survey showed that after just one year of Medicine, students could be in up to £16,000 of debt. In total, 623 first year medics and dentists replied to the annual survey with two thirds saying they’d have to cut back on food to survive. This comes at a time when Student Finance maintenance grants and loans rise by less than one percent, lower than the rate of inflation. This has forced many to pursue high interest borrowing such as commercial loans and credit cards to supplement their income. Medical students work more hours per week and study an additional two years compared to conventional degrees. The possibility of debt is a real concern that hangs over the head of students; with graduates studying a second undergraduate degree hit the hardest. No student finance support

for tuition fees means that graduates have to pay £9,000 upfront for the first four years. One graduate in the BMA survey already owed £84,000 going into his second year. Since the rise in tuition fees, the debt for medical students has almost tripled with a 2010/2011 graduate owing just £24,000 while a student entering in 2012 could owe £70,000. This is an enormous leap in debt and puts pressure on students already under enough academic stress. Jo Wagland, a first year medic at Barts and The London, said “Four years of maintenance loans really scares me – it makes me wonder if the increased earning potential we will have will be worth it in the end, especially as it takes so long to work up to a consultant’s salary.” With increasing debt and Oxford University asking to raise tuition fees further, future medical applicants could be forgiven for having second doubts.

Daniel Gibbons, former Deputy Chair of the BMA Medical Students’ Committee, agreed that such high debts would put anyone off entering the medical profession. “Medicine is already significantly more expensive than other courses, and our research shows that the problem would worsen with the introduction of top-up fees. The government’s measures … fail to take into account the fact that medical students study for an extra two or three years. On top of this, we face extra costs for travel and equipment, and have fewer opportunities to supplement our income through paid work.” The demands of a medical or dental course can be incompatible with a part-time job, yet the BMA survey showed that more than half of the respondents (57.5 percent) are thinking of taking paid work to support their studies. The pressure on students to seek [cont’n on page 2]


theMEDICALSTUDENT / November 2013 News Editor: Chris Smith


[Editor's Letter]

t’s been a busy month for the paper, our diligent editors have travelled across London to the various Freshers’ Fairs and what a response we’ve had. In excess of 200 of you signed up to write for us, and I’m extremely pleased to welcome a number of new faces to the editorial team: Our News editors, Chris Smith and Krishna Dayalji; the new Education editor, Sarah Freeston and our Features sub-editor, Narmadha Kali Vanan. If you didn’t get a chance to get involved, don’t worry - we’re still looking for a treasurer and online editor, and, as always, if you do ever want to write an article don’t hesitate

[Editorial Team] Editor-in-Chief/Peter Woodward-Court News Editors/Chris Smith & Krishna Dayalji Features Editor/James Wong Comment Editor/Robert Cleaver Culture Editor/John Park Doctor's Mess Editor/Zara Zeb Education Editor/Shivali Patel & Sarah Freeston Sports Editors/Mitul Patel Images Editor/Upi Sandhu Treasurer/Jen Mae Low Illustrators/ Jack Day (p1), Edward Wong (p8-9), Alexis Nelson (p10)

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> [cont’n from Transfer article] ...Addenbrookes.” All Cambridge students will continue their clinical education in hospitals based in East Anglia and Health Education East of England supports Cambridge’s developments. In our correspondence with Cambridge, they remarked that a great deal of consultation had taken place in preparation for these changes, both internally and externally, and claimed that London had been aware of

Cambridge’s intentions since 2011. Conversely, when TMS spoke to senior staff in London, it was remarked that “Cambridge have made a unilateral decision…this was done without any consultation; they were not open to discussion and there are no mitigating circumstances. There’s been a series of exchange of letters, which are perfectly polite, but the answer is a blunt ‘no’”. Another source told us: “We’ve been aware that it might happen for about 12


to get in touch. We have a packed issue for you this month, starting with the latest on UNISON’s industrial action and Barts’ impressive start to the RAG season (page 4-5). In Features this month we look at the blessings and curses of Wikipedia and also kick off our first in the series of iBSc reviews. We also hear about the devastating cases of polio in war torn Syria, which marks the first outbreak in 14 years (pages 7-10). Many of you will have spotted the adverts on the Bus and Underground depicting a distraught individual who has just received a diagnosis of diabetes - is this undue fear mongering? We go head-to-head in Com-

ment (page 12) and also hear about the dangers and detriments of an overly competitive culture in medicine (page 13). With the year now in full swing and the frivolous spendings of freshers’ week behind us, our article on spending money in the City wisely gives valuable insight on how to avoid breaking into the dreaded overdraft (page 14) and we also take a look at the latest apps for improving our medical education (page 15). A few weeks ago I could scarcely get away from a conversation about Breaking Bad and this month in Culture we look at the wider impact it might have on our television screens (page 20). Also, we

take a look at ‘Still Life’; ICSM’s recent drama production. This issue is rounded off with Doctors’ Mess and our prize crossword where you stand to win another expensive, well reviewed book absolutely free of charge. My adaptation to clinics continues to be shaky, and I feel more a hindrance than a help in almost all aspects of life on the wards. I now look enviously at the luxuries of ‘reading’ weeks and free Wednesday afternoons and wonder what I did with all my time in preclin considering I am now unable to answer even the most basic question on physiology from the expectant consultant. Onwards and upwards!

months or so. The actual proposal came out of the blue and with a set time limit – there’s no staged approach, there’s a big bang from 2017. We’re very keen to meet with Cambridge, but Cambridge seem to think there is no need for discussion.” “Cambridge does not reflect the diversity of the population of London, and that diversity is important when learning medicine. But that’s the choice of Cambridge. I do think there needs to be that opportunity for students to understand it better. I’m not certain whether the students coming into Cambridge are aware of the circumstances from 2017.” Despite this difference in viewpoint, Cambridge claims it has involved its own students, the Clinical Students’ Society commented: “The current system causes significant disappointment every year to students who are not able to stay in Cambridge”. TMS enquired about this, and spoke to a handful of recent transfers to London. All the students we spoke to disagreed that the transfer method caused significant disappointment and were unanimous in their appreciation of having the opportunity to transfer. This was true even in a student who was not enjoying her time at London. This was recapitulated by the senior colleagues TMS spoke to: “At least you want to have the opportunity. Because for some people it’s not right to move, for some people they would prefer to stay in Cambridge with their friends, and some people would prefer to stay in the college environment, but it’s about choice. You have to be able to

decide what you want to do, and not be constrained by politics or inflexibility. Cambridge [is] not acting in a terribly honourable fashion in that the thing is driven by money rather than the student experience. It’s destabilising a system that’s worked very well for many years. The other point that we are just as concerned about is the fact that so many Cambridge students say to us how they relish the opportunity to divide their time between Cambridge and London. From the perspective of the clinical experience, the wonderful experience that is valued by students from being in London. I do feel at the end of the day the argument should be one primarily on education and of the variety of education. I don’t hold that six years at Cambridge will provide great innovation and continuation of education. I’d like to see the evidence for that.” All this comes at a time when London hospitals are facing a £2bn cut, and the loss of Cambridge students will contribute a further £24m deficit. Asking whether the significant cuts to London hospitals would affect the quality of clinical education: “Well, hopefully we would work hard to preserve the experience. The hospitals will still be here. It shouldn’t be that apparent, it’s a question of whether it will affect things in the long term. [The hospitals] won’t slip in terms of performance, nor in reputation or prestige. But we may need to approach the government for more funding – it’s a solution. Money will be tight and we may need to be more imaginative.”

> [cont’n from Student Debt article] additional income is so great that they can compromise their attendance at university. Shockingly, the NUS Pound in Your Pockets’ survey found that only six out of ten NHS-funded students were in receipt of a student loan. This resulted in a medical students being more likely to turn to their parent university or family and friends for financial support. NUS subsequently found that more than two thirds of students were worried about debt. The Barts and The London Medical School’s Dean of Medicine, Mike Roberts, was so concerned about the financial burden students are facing that he pushed for funding to help students find part-time work. Queen Mary’s career services now has a dedicated staff member to source part-time work for medical and dental students. Maria, Research Assistant at Queen Mary, says that since starting her new role students have quoted “needing money to survive or supporting parents as the primary reason for applying for jobs”. Kate McFarlane, Student Finance and Bursary Manager at QMUL, says the worst is yet to come, predicting that “students on the £9k fees” will struggle to support themselves “when they are mid-way through their course”. Unfortunately, money concerns do not stop when you graduate. MacFarlane said that most students have “exhausted all sources of funding by this stage” and have to turn to a ‘transition loan scheme’. This £1,000 interest-free loan is “very popular” at Barts, helping to bridge the gap between student and working life. Student Finance England has yet to announce funding for students starting their studies in 2015/16.


theMEDICALSTUDENT / November 2013 News Editor: Chris Smith

Medgroup Chairs Dheeraj Khiatani & Mark Gregory ‘October is always a busy month for everyone at medical school. Whether you’re involved in running sports teams, societies or just trying to settle in to a new year, you’re always guaranteed some big nights and long days. Busiest of all of course are the union presidents from our 5 schools, without whom very little would happen! Our first Medgroup meeting has happened and plans for 999 on the 25th November are well underway. It’s always an enormous night so get your tickets early and schedule the Tuesday morning off to recover. See you all there!’

GKT President Juliet Laycock Things at GKT are as lively as ever. The new intake of freshers are proving to be some of the eggiest we’ve known, and they’ve certainly made an impression on the older students! We’re very pleased to announce the reopening of our sports club house at Honor Oak Park. When the sports ground was first opened 77 years ago, Guy’s Hospital rugby club (the oldest rugby club in the world!) played against Cambridge to mark the occasion. So this year, to mark the re-opening a rematch was played. Crowds turned out in their dozens for an - albeit very wet - highly enjoyable day, with GHRFC coming out victorious. The KCL Medical Students’ Association is also very excited to be working alongside KCLSU in order to increase the maintenance loan for Medical Students - watch this space! Future dates for the diary include the ever elusive Beaujolais Nouveau, and the GKT Christmas Show on 27th-29th November

RUMS President Swathi Rajagopal So we’re a month into term and freshers’ fortnight already seems like a hazy, distant memory. However, this year’s freshers have excelled in the art of partying, leaving a lasting impression in the form of hundreds of empty wine bottles, pizza boxes and a range of goodies scavenged from various parts of London. After your initiation into the true spirit of RUMS, and a significant dent in your student loans, it’s time to show us what the class of 2019 is made of! RUMS have stepped straight back into sports, training hard and ending sports nights in true style - stumbling home via the chippy. RUMS Rugby have set the tone for the year, reaching the finals of the UH7’s tournament and displaying an impressive win against Imperial in their first game of the season - a sure sign of what’s to come for RUMS sport. Over the next few months, keep your eyes peeled for future events on our packed calendar (details of which can be found on Get involved with 999 an all-London-medical-schools club night, naked calendar, taboo week and, of course, our fabulous winter ball. That’s all from me for now!

SGUL President Mohammed Amer Ok so Freshers’ Fortnight was a hectic time, but we ended sophisticatedly, finishing at St. Paul’s Grange Hotel; a five-star hotel overlooking St. Paul’s Cathedral that really got everyone looking swish in their glad rags. November brings us into show season! We kick off with a Diwali show, who are very innovative this year, using a twist on the Wizard of Oz story to brand their talent. We will see a range of impressive acting, dancing and singing from some of the greats from George’s, as well as the new keen theatrical freshers we have coming through the ranks. Following that we have the Fashion show, our dance show that confusingly isn’t anything to do with a catwalk! Brandishing a tasty Charlie and the Chocolate Factory theme, they are sure to get everyone’s jaws to drop with the talent of dancing and unique choreography, as well as the well-known men and women’s underwear dances! If all that wasn’t enough, we have the launch of our Quiz kNights league, where teams battle it out to win top notch prizes, as well as Dragon’s Den; a sport night led by one team per month. On the academic side, we see the voting in of our new year reps and various talks on malaria eradication, pre-hospital care and a medical ethics debate to top it all off.


ICSM President Steve Tran Finally! Freshers’ Fortnight is over until next year. The last month has been a whirlwind experience at ICSM. We ended our famous Doctors and Nurses at Heaven and had a very successful Beach Bop at our refurbished Reynolds’ Bar. Somehow Imperial medics are probably the most fed students in London this month. In addition to the usual freshers’ antics, we’ve had the inaugural School of Medicine Welcome Dinner for first years to meet their academic tutors as well as our annual Halfway Dinner. Our dinners don’t end there with our annual Shrove Tuesday Final Year Dinner (yes we do realise that Pancake Day is not in November), the Summer Sports Dinner and the first Arts Dinner all to come next month. With United Hospital Sports Night coming up, we at ICSM look forward to seeing all of you there!

BLSA President Ali Jawad Greetings all. Over the past few weekends, BL has been host to 4 national conferences, covering a wide range of topics. Starting from the end of September with the Anatomical Society’s Conference, then the Academic Medicine and Surgery Society, the Cardiology Society (in partnership with the British Undergraduate Cardiovascular Association) and finally just last weekend, Street Doctors. All of the conferences have received tremendous feedback and it reflects the work that BL students put into the initiatives they care about. This speaks volumes of the activity of our students, and continues to cement us as one of the best medical and dental schools in the land! The next few weeks will see a build-up to exams, especially dentists, so good luck to all!


theMEDICALSTUDENT / November 2013 News Editor: Chris Smith


Barts and the London’s Crash Course to RAG Narmadha Kali Vanan Features Sub-Editor To kick off a fresh new season of Raise and Give (RAG) within London, Barts and the London’s RAG (BL RAG) held their much anticipated Crash Course on the 16th of October after a successful RAG Raid in Brighton. Over 60 medical students took time out of their busy schedules to raise

money for charity, managing to raise over £5,500 altogether. The nominated charities for this year were Breast Cancer Campaign, Macmillan Cancer Support and Médecins Sans Frontières (Doctors without Borders). Students could also raise money towards personal fundraising targets for RAG Challenges such as Lost, the London Marathon and the London-to-Paris Bike Ride. The day kicked off at 6am at

the Student Union, with freshers and seniors alike coming along to pick up their collection buckets. They then set off to selected London Underground stations to raise money, all dressed up with scrubs and colourful onesies. By 10am, the first buckets started arriving at the Student Union, with their owners, eager to find out how much they had raised. Emma Sykes, a second year medical student,

managed to raise the most money with a whopping total of £535! The RAG Office stayed open until midnight, with students returning from various locations such as Bank and Canary Wharf with heavy buckets and smiling faces. Gwyneth Jansen, BL RAG’s Captain said, “The highlight of the day, for me, was when the first buckets arrived in the morning! They were so heavy and it was great as it

set the mood for the day. The atmosphere in the RAG Office throughout the day was amazing too!” She also added, “This event has been quite a success and it was a great step forwards in terms of getting more people involved with BL RAG. We have many events in the pipeline, such as RAG Week next February, and we’re hoping many more people will join in the fun!”

Emma Sykes, a second year at Barts, raised £535

UCL Students Sweep the Board Winning £1,100 in Prizes from Nick Ross Chris Smith News Editor University College London (UCL) students of medicine and allied professions have scooped 3 out of the 4 prizes offered in a national competition, receiving cash prizes from journalist and broadcaster Nick Ross. Fifth year medic Dylan Mac Lochlainn along with biomedical engineers Henry Lancashire and Shuchang Liu were winners of The HealthWatch Student Prize, in which students show their skills in assessing research protocols. Since 2002, the annual competition aims to raise awareness to the general public and media on why well-designed clinical trials are the best for pro-

ducing effective treatments. Mac Lochlainn, Lancashire and Liu were able to critically appraise clinical trial protocols, explaining their reasoning for whether the results would hold credence in the scientific community. Topics ranged from varicose veins to cherry extract as a treatment for gout. The awards ceremony was presented by Nick Ross, broadcaster and President of Healthwater, and was held at The Medical Society of London on 24th October. Mac Lochlainn won first place for Medical Students (£500), while Lancashire and Liu won first place (£500) and runner-up (£100), respectively, for Allied Professionals. There was also a presentation by

Fiona Godlee, editor of the British Medical Journal. HealthWatch reaches far and wide in the scientific community with prominent doctors and Nobel Prize winners credited as members. UCL clinical research scientist, Walli Bounds, also a committee member and competition organiser, said “It is essential that our future doctors and nurses are taught the key features of well-designed clinical trials, so they can distinguish between valid research findings and poor-quality or misleading results. This competition aims to encourage students to test their knowledge about what proper scientific testing entails, and thus lead to better patient care.”

Dylan MacLochlainn, Schuchang Liu and Henry Lancashire

[NEWS] /5 Barts sets Precedent for Europe with Second Year of HIV Testing theMEDICALSTUDENT / November 2013 News Editor: Chris Smith

Chris Smith News Editor Barts Health NHS Trust was part of a pioneering National HIV Testing week last year, so admired, that this year all of Europe is participating ahead of Worlds AIDS Day. Based on a successful pilot scheme at the Royal London Hospital, Barts Health, Britian’s biggest health trust, covering 2.5 million patients, aims to test 2,500 patients during the week – Friday 22nd November to Friday 29th November 2013. The trust has recently in-

troduced opt-out HIV testing at all six A&Es for patients receiving a blood test, as The Royal London’s population includes Tower Hamlets which has a disproportionately higher risk of HIV than any other area of the UK. Building on the trust’s success, this is the first time a large-scale testing programme has been offered by the NHS. Testing week requires a significant work force and is relying on medical students at Barts and The London Medical School to help accomplish this task. The medical students will be working alongside consultants and nursing staff gaining

consent, booking patients into virology and taking bloods. The aim of HIV Testing week is more than just diagnosing HIV positive patients; its intention is to change the attitudes and prejudice associated with a HIV diagnosis. Rachel Bath, the HIV specialist nurse who ran the original Royal London trial, said: “The pilot work has shown that opt-out testing is highly effective at shifting late HIV detection to early detection. The project also made our non-sexual health clinicians more aware of HIV and facilitated retraining on the need to test.”

Higher Education Unions Bring Universities to a Standstill Chris Smith News Editor UCU, UNISON and Unite trade unions took industrial action on Thursday 31st October. With UCU representing over 120,000 academics

and university staff, this is the first national strike by the three main unions. Teaching staff were striking over an offered pay rise of one per cent, which is effectively a 13 per cent paycut since October 2008. Will Hutton, former editor-in-chief of The Observer,

described the negotiations as ‘the largest sustained wage cuts any profession has suffered since the Second World War’. The UCU’s elections saw a 35 per cent voter turnout with 61.5 percent voting to strike. For Unite, the turnout

for the ballot was 28 per cent and of these, 64 percent (1,654 members) voted in favour of action. The strike comes at a time when university leaders have seen an increase of pay and benefits, on average, by more than £5,000 in 2011-12, with the average pay and pensions package for vice-chancellors hitting almost £250,000. A real concern is for medical and dental students whose timetables are traditionally intense, lacking flexibility. The loss of a day of lectures can have a domino effect on a student’s workload. A King’s College spokesperson said that the “College would be open for business as usual” with “plans to minimise disruption to teaching” while a UCL spokesperson added, that medical and dental students would not be “significantly affected” by the strikes. University of London Union’s senate and Queen Mary’s Students’ Union’s student council motioned to support the strikes with Paul Anderson, President of QM UCU Local Committee, confirming

UCU members in Barts and The London’s School of Medicine and Dentistry. Unable to confirm the full extent of the effect on the School, Anderson clarified that staff on clinical pay scales were not involved in the industrial action. NUS were also quick to rally support for the strike with Toni Pearce, NUS National President, and Rachel Wenstone, NUS Vice-President (Higher Education), writing to all student unions explaining NUS’ position. However the Universities and Colleges Employers Association (UCEA), which represents universities as employers, said it was disappointed by the decision to strike. “Our Higher Education Institutes tell us that the vast majority of their staff understand the reality of the current environment and would not want to take action that could harm their institutions and their students.” At the time of print, no agreement had been reached and the industrial action was still planned.


theMEDICALSTUDENT / November 2013

Features Editor: James Wong


Suspected Syrian Polio Cases A symptom of the war-torn nation’s diminished health system

Oliver Collas Guest Writer The preventable virus, which affected 45,000 British residents per year as recently as 1950, may now have returned to Syria. Possible polio cases in eastern Syria are under investigation from the World Health Organisation. If confirmed, the war-torn nation faces its first outbreak since 1999. Amid the perils of civil war, the Syrian health system is crumbling, leading experts to question whether this will be a sole occurrence. Originating in the province of Deir al-Zour, the cluster of suspected cases are thought to be caused by a reduction in vac-

cinations caused by the ongoing conflict. Since the outbreak of violence, vaccination rates have plummeted- from 95% in 2010 to 45% in 2013, as reported by the BBC. The Syrian Ministry of Health states it is responding through an emergency vaccination campaign in the area, as well as increased surveillance for additional cases. However, experts remain sceptical and concerned. With ongoing civil war, the vaccination campaign will prove difficult. In an effort to contain the outbreak, the WHO is urging neighbouring countries to perform supplementary polio vaccination campaigns. The outbreak comes as no surprise. Instead, it is symptomatic of the Syrian health system’s current state. Fight-

ing has partly or completely destroyed half of the country’s 88 public hospitals, with 23 of them totally non-functional. Medical services continue to be targeted by armed groupsactions condemned by global leaders including former director-general of the WHO, Gro Harlem Brundtland. “I am very concerned by the deliberate and systematic attacks on medical facilities and personnel in Syria,” Brundtland states. In addition to deliberate attacks, Brundtland adds that health services are hampered further by rebel groups blocking medical supply convoys, whilst aid personnel attempting to enter the government are being denied visas. On a global scale, the UN appeal for humanitarian funding remains less than

one third funded. Furthermore, Syria faces a drastic shortage of doctors and pharmaceuticals. In a joint letter to The Lancet medical journal, 55 medical experts from across the world voiced their concerns on the deteriorating Syrian health system. They highlighted that approximately 15,000 doctors have been forced to flee abroad, whilst another 500 remain imprisoned. The disappearance of physicians is most visible in the city of Aleppo. Of the 5,000 physicians that used to practice in the city, since the conflict started just 36 remain. The reduced availability of pharmaceuticals also continues to thwart those in need. Before the conflict, in 2010, over 90% of the country’s drugs were produced by Syrian facto-

ries. Their output has dropped by over two-thirds, fuelling an overpriced black market. We should not only consider the health system itself. Crucially, over 5 million Syrians are internally displaced, with the majority living in unsanitary, overcrowded conditions- a ripe scenario for virus spread. Syria is not the only country struggling with polio re-emergence. Of the 296 documented cases worldwide this year, over half have occurred in Somalia, which had previously eradicated polio in 2007. Polio cases have increased on 2012 levels, when all 223 incidences were from remote areas of Nigeria, Afghanistan, and Pakistan- the only countries where polio is still endemic.

[FEATURES] /8 Wikipedia - A help or hindrance?

theMEDICALSTUDENT / November 2013

Features Editor: James Wong

James Wong Features Editor It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell-tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia. Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritise the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering

which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications. We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. ‘Just Google it….’ is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape. The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely, textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to

bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, laypeople, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter, patients), expect from an encyclopedia. Since the prestige of direct authorship is off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanities lot’ is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant sideeffects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and

banishing rebellious editors. A study featured in the First Monday Journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors. Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having

some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury. March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice.

Write for Us! The Medical Student is always looking for keen writers to get involved with the paper, if you have an idea for an article, big or small, don’t hesitate to contact us:


theMEDICALSTUDENT / November 2013

Features Editor: James Wong


iBSc Review - Imaging Sciences James Wong starts off our new series of iBSc reviews James Wong Features Editor I know what you’re thinking: “Pah imaging sciences, it’s a tailor-made course for the aspiring radiologist.” While true in some respects, let me make my case. The image of a benighted office, goggle-eyed over a fan of computer monitors was not the reason for my application. No matter which career path I follow, I am going to encounter imaging. Some might be saddened to hear that this solitary year has endowed me no advantage when reading chest Xrays, but that was not the goal. The first term focused primarily on the theory of radiological techniques, divided into the radioactive sort: X-ray/computer tomog-

raphy (CT) and nuclear medicine (SPECT, PET, brachytherapy etc) and the non-radioactive: magnetic resonance imaging (MRI) and ultrasound. The second term dealt with the more clinical aspects of each modality. It was all lecturebased material. Although fewer lectures in number compared to MBBS, they were more weighty. As medical students we are accustomed to having almost no teacher-pupil contact during our preclinical years. It was refreshing to have the attention of the lecturers; to in a small way become familiar with them over the regular timetabled teaching each week. As our attention turned to clinical applications we found ourselves visiting the different departments, observing scans and receiving teaching from clinical staff or researchers.

The breadth of teaching was comprehensive: functional neuroimaging, brachytherapy, radiotherapy, image-guided intervention, advanced imaging techniques are just a few examples. MRI was for me, by far the most enchanting image technique. For most medics, the last contact they had with any sort of MRI was at chemistry A-level. The concepts are so utterly different and require that much more time to digest compared to the more familiar workings of an X-ray image. Among the core teaching were opportunities to go hands-on with ultrasound equipment at Guy’s Hospital. Ultrasound is such a user-dependent modality and in our uneducated hands, it showed. In addition to coursework, each student was assigned a case study to present in

a grand roundesqe style. Despite constituting a small part of the course, combining the theoretical knowledge with clinical application felt strangely empowering. Of course, as with any iBSc, you have the chance to discover what research tastes like by writing your own dissertation under the guidance of a supervisor. In hindsight I feel a little spoilt, that I had the pick of many ongoing projects at the Division of Imaging Sciences & Biomedical Engineering, a prestigious research facility. The project I had chosen was on PET imaging of the hip bones, the different algorithms used to reconstruct the image data and how they might be used to solve the problem of noise encountered using the standard reconstruction technique. Luckily for me the required image data had already been recorded, it was my job to process the data and generate results using a Matlab program designed by the Osteoporosis Unit. Although there is ample desk time set aside for your project, the drafting and redrafting of a dissertation in collaboration with your supervisor requires planning and steadfast commitment. Having seen a couple of PhD theses by my superiors, the quality of writing and the expectation seemed sobering. As I soon learnt, writing in a scientific style did not come easily, which was well reflected by the number of redrafts required and the healthy amount of

email correspondence I shared with my supervisor and staff in the Unit. It was a steep learning curve and while I might have felt lost at times, thankfully I had encouragement every step of the way. A ten minute viva presentation formed part of the assessment of the written dissertation. As means of preparation, my supervisors kindly volunteered my name for the forthcoming departmental meeting in the Imaging division. Presenting before an audience of impeccably well-lettered members of any department strikes as an intellectually dwarfing experience, but it does teach you the value of structured criticism. So what have I learnt from that iBSc year? Well, the whole project writing process puts you in better stead for all future library projects. Researching, writing, and presenting come with much more ease. Obviously this particular skill set is not unique to any one iBSc but it’s the most immediate and lasting benefit I have noticed. During clinical years, exposure to imaging techniques and reports is unavoidable, whether its echocardiography, FDG PET or one of the more exotic MRI pulse sequence, I’m glad to say they are not totally unfamiliar terms. If you have a burning interest in physics, computer imaging or see yourself as an aspiring interventional radiologist this is the iBSc for you.

[COMMENT] /10 No More Doctors Without Borders theMEDICALSTUDENT / November 2013

Comment Editor: Rob Cleaver

David Fisher Staff Writer As a medical student, it would seem odd if a consultant required us to check the immigration status of our patients in clinic and yet this could soon become a reality. Critics of new government proposals suggest that if they were implemented, wards and surgeries would be turned into Border Agency outposts. The NHS was created following the enactment of the National Health Service Act in 1946. The sole purpose of this radical initiative was to secure “improvement in the physical and mental health of the people of England and Wales” and was free of charge. UK citizens continue to enjoy free healthcare funded by taxation, including National Insurance contributions. The UK has reciprocal free healthcare agreements with a number of countries. Since 2009, the arrangement with countries in the European Economic Area (EEA) ensures that when a visitor is treated, the home country is billed using details set out in the person’s European Health Insurance Card (EHIC). Tourists (visitors who spend less than 6 months in the UK) from outside the EEA do not pay to visit a GP practice but are charged for hospital treatment. Individuals from outside the EEA who can prove ‘ordinary residence’ are entitled to free NHS care. ‘Ordinary residence’ is a vague term. Anyone who can show they will be living legally in the UK for the foreseeable future can prove ‘ordinary residence’. This includes temporary migrants who obtain student or work visas. The problem, however, is that the flexible definition leaves the NHS vulnerable to abuse by people who obtain visas for the sole purpose of obtaining free healthcare; health tourists. “What we have is a free national health service, not a free international health service”, David Cameron proudly announced to the world. The government believes allowing temporary migrants free access to the NHS is too generous and

is eager to cordon off the avenue of health tourism. After all, temporary migrants have not been making National Insurance payments and have not paid for the right of free care. So the Government proposes a new definition for ‘ordinary residence’ which limits free healthcare to migrants with current residence in the UK and indefinite leave to remain (i.e.: living in the UK for 5 years or more). Individuals who do not qualify for ‘ordinary residence’ will have to pay a migrant health levy of £200 per year. Also, those people who have private health insurance cover will be allowed to waive the levy and be charged for their NHS care. The government recognises that significant improvement in organisational systems will be required to identify chargeable patients but hopes that an electronic record will be created to identify the status of a patient’s entitlement. Emergency care, treatment of infectious disease and sexually transmitted infections will be exempt from charge and certain expensive treatments will also be unavailable or charged separately. Following the announcement of these proposals, a consultation period was set to allow organisations to provide their views. Understandably eyebrows were raised and a growing list of problems were identified. First, the current technological infrastructure is inadequate to distinguish between patients who are and who are not entitled to free healthcare. Secondly, the government has glossed over precisely how expensive the necessary upgrade will be and the length of time needed for implementation. Thirdly, the proposals are risky. Patients who aren’t entitled may hesitate to seek healthcare which could delay detection and encourage spread of communicable infections. Fourthly, there is a risk that foreign skilled workers, including healthcare professionals, will feel less incentivised to come and work in the UK. And finally, it is debatable whether the proposals are a worthwhile use of money. Little data has been accumulated to show how much money is

Illustrated by Alexis Nelson

spent providing non-EEA migrants with healthcare and is lost due to health tourism.

[Although it may be a bitter pill to swallow, there is surely a case for arguing that the UK should start by restricting free healthcare to its citizens] Putting aside the practical difficulties, the fundamental question remains, should the UK provide free healthcare to temporary migrants who have not paid National Insurance contributions? It is clear that, to remain affordable for the next generation, the NHS requires massive restructuring and although it may be a bitter pill to swallow there is surely a case for arguing that the UK should start by restricting free healthcare to its citizens and long-term residents. The criticism that the pro-

posals are uneconomic because relatively little money is currently lost may be unfair. An independent audit recently published suggests up to £80 million was spent on health tourists and up to £1.4 billion spent providing healthcare to non-EEA visitors and migrants between 2012 and 2013. The authors note that these figures could underestimate the true costs. If hospitals identify and bill chargeable patients, they are unable to reclaim the cost of treatment from NHS commissioners and must rely on the patient repaying the amount. This increased administrative burden may be encouraging hospitals to turn a blind eye when confronted by patients ineligible for free healthcare and the actual cost to the NHS could be far greater than £1.4 billion. The other concerns about implementing the government’s proposals could be resolved

with some minor adjustments. At the present time, the healthcare system assumes patients are entitled to free healthcare. The proposed optional NHS levy reverses this assumption. By providing an option to waive the levy, it will need to be ascertained whether every temporary migrant patient is entitled to free care, rather than simply assuming they are. Yet if the NHS levy instead became mandatory without an option to waive, it would be less challenging to implement. If all individuals with visas pay the levy, it could be assumed they are entitled to free healthcare, without need to check. This system will be more closely aligned to the current system and easier and cheaper to implement. It would also be consistent with the original purpose of the NHS - “to secure improvement in the physical and mental health of the people of England and Wales”.


theMEDICALSTUDENT / November 2013

Comment Editor: Rob Cleaver


How the Mentally Ill Pose a Greater Risk to Themselves Than to Us Rob Cleaver Comment Editor We of the 21st century are very much in favour of purging the prejudices that still lurk in the dark back alleys of Britain. We are plodding progressively towards an enlightened world where women are no longer discriminated against and also towards a disability, racially and religiously inclusive society. To these ends, the elimination of stigma towards mental health has been a key agenda on the tongues of many and to some extent we are getting there – depression in particular is a more widely understood and acknowledged problem than it was even ten years ago. However, there are those unpalatable times when the media fire their ceaseless cannon of scaremongering into the British public to once again whip up a debate whose shrapnel was best left in the dark ages of alcoholic anaesthesia and leech therapy. In the past few weeks, the BBC have reported widely about the 96 people murdered by mentally ill patients since 2005 in London and, as any selfrespecting news agency would, thought best to leave out the further evidence regarding the vastly increased rates of suicide amongst the same section of society. The portrait they painted was thus – people suffering from a mental health disorder are capable of and will attack someone that you know.

[It is this kind of publicity that tops up the levels of stigma that are expressed by the lay public, rebuilding the wall that has ostracised so many for so long that previously, brick by brick, had been on its way down] Of course the statistics are publicly available; The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness based at Manchester University concluded that homicide rates were actually decreasing over

this period and that the final year that they have concrete data for actually saw the lowest rate since records began in 1997 reflecting only a 9% share of total murder convictions in England. Suicide rates, on the other hand, are on the rise amongst mentally ill patients with numbers up 200 since the previous year which contribute a rather heftier 32.5% of the annual suicide rate in England. This, regrettably, is not the story that most of the general public will have seen. They will have seen themselves as potential victims at the hands of very vulnerable people who themselves, and even the BBC acknowledge this, are three times more likely to be the victim of a crime than someone without previous mental health contact. It is this kind of publicity that tops up the levels of stigma that

are expressed by the lay public, rebuilding the wall that has ostracised so many for so long that previously, brick by brick, had been on its way down.

[Qualification of the information on the bottom of the web page at a later date will have done very little to right the salaciousness of the initial broadcast] What most recently riled me about this coverage is that the story on the website now carries the message, “this story has been amended in light of new information from the Ministry of Justice, putting the figures into more context”. Qualification of the information on the bottom of the web page at a later date will have done very little to right the salaciousness of

the initial broadcast because the wood was not seen for the trees. How many will have gone to such lengths as to reread something they read or heard about days ago as they clamber keenly for their daily fix of worldwide miserabilism? There is no doubt that each individual murder case is a tragedy; no one deserves to be attacked in this way by anyone, mentally ill or not. There is also no doubt though that there are those few who are failed by a vastly underfunded and overly stretched mental health service in the UK who then go on to harm other people. However, with murder rates decreasing it is evident that we surely must be doing something right, a notion of positivity often overlooked by the press, whilst suicide rates are on the increase. Surely the most reportable

findings from this inquiry are that mental health trusts are failing to prevent some of the most vulnerable in society from ending their own lives – this is where the failure in the system is most apparent. The disparity between the true picture, that of vulnerability, and the bloodthirsty image that the press has portrayed is highly visible, to me at least. There will always need to be progress in mental health safeguards, support services, frameworks and facilities because we can always try to do better. However, with negative press from unenlightened, selective statisticians we allow the mentally ill to become invisible once more, drifting back into the shadows of a pre-inclusive and retrogressive society in which danger truly lies.


theMEDICALSTUDENT / November 2013

Comment Editor: Rob Cleaver

YAY! We all need to wake up and stop relying on the healthcare professionals working for the NHS to magic away years of destroying our bodies. As carefree, immortal individuals, we never think in twenty years’ time our bodies will be tired of processing all the sugar we shove down our gullet, or our heart will be fighting against our clogged up plumbing, or that anything we do now will actually do us any harm. How naïve can you be? The NHS is a great service that is sadly overburdened. Private healthcare services are popping up everywhere cashing in on our ignorance. Chain pharmacies offer free diabetes risk assessment and I can’t help but be cynical that sooner or later not only will prices for medication be extortionate, but we will lose our most precious resource, the NHS. Health care in my future may no longer be free or certain services will be redirected to private businesses, and I certainly don’t want to have a reason to see the GP every six months. One in ten adults now have type 2 diabetes in Britain’s hotspot (Brent, North London). Diabetes isn’t a death sentence in today’s medical world where if managed correctly patients go on to live to their full life expectancy. But we don’t have the resources to manage an increasing number of patients who don’t want to help themselves. Those posters every Londoner has no doubt seen splashed across buses and the underground overexaggerating the finality of diabetes send home an important message: prevention is the best cure. Some diseases can usually be avoided through a healthy lifestyle where we choose walking over escalators, sports over cinema trips, and health over disease. Being healthy isn’t a punishment: health keeps the body invigorated so productivity and fun increases. Being healthy doesn’t mean you give up your favourite food: it simply asks for moderation and portion

control. Being healthy means living disease free for longer. Maybe I make a fool out of myself in every sport I play for four hours every week, but if those four hours will keep me disease-free, then it’s a sacrifice I am willing to make. The NHS should treat all diseases, but we shouldn’t expect the NHS to kiss us better when we hurt ourselves. I admire the honesty of the campaigns that are making us wake up and take responsibility for ourselves. I can only hope that we realise that we

Although I agree that there are times when a well-executed campaign requires gravity, We have to remember that patients aren’t stupid. Every smoker you’ve met knows smoking is bad for you. Telling patients what they already know in a confrontational way isn’t enough, and may even do more harm than good. We’ve probably all heard patients rant that ‘everything causes cancer’ these days according to the papers, so that there’s ‘no point in trying’. This isn’t just healthy scepticism, but disenfranchisement that puts patients at risk by discouraging them from engaging with healthcare services. Shoddy science reporting has contributed to a weakened trust of the information provided by doctors. If we as a health service don’t try to carefully control scaremongering we risk being seen as the boy who cried wolf

SHOULD THE FEAR FACTOR BE PART OF HEALTH AWARENESS CAMPAIGNS? FOR - ZARA ZEB [GKT] -VSAGAINST - CHRISTINA KRIVCEVSKA [BARTS] have one body, and that once ruined, we don’t get another chance. My favourite advertisements on the underground are the ones which encourage parents to talk to their children about alcohol, placing responsibility exactly where it should be. Parents can’t make their children do anything, but they can influence them and guide them. Education with anything is key. Habits are formed when we are younger by what we are taught. These habits are then difficult to change, but change can happen. Since starting medicine my own habits have altered slightly. It’s a slow process and I’d rather change now rather than trying to change when my body has no hope of recovery.

and lumped in the same category as irritating tabloid articles about how everything is bad for you. I’m not saying we shouldn’t put the facts out there, nor that we shouldn’t be blunt about them. But I am pointing out we need to be very careful not to saturate the public with hard-hitting messages until they grow desensitised or disinterested. I wonder how many smokers even notice the vivid pictures of lung cancer on cigarette packets now. Can you imagine if we treat-

ed every vaguely serious health problem with the same fervour? I’ll admit, however, that I am a bit conflicted. Yes, I can see how in theory, more scared patients may lead to more people taking up healthier behaviour, which looks good on paper. But it doesn’t take into account human nature. That too much scaremongering can cause people to switch off; after all, nobody likes being told that they’re going to die horribly, even if it is the truth. We need to work with the human psyche, not against it. The doctor-patient relationship has evolved, patients’ requirements for information have changed, and our approach has to shift with these trends. Doctors are not the only source of information any more. Patients come to us having Googled their symptoms and read other patients’ experiences on forums as soon as they’ve left us. Our patients have so much information on their hands that the real challenge we face may actually be how to direct them to that which matters most. And for that we need to treat patients with subtlety and maturity.  Hence why I believe we need to be smart and subtle about campaigning. That means less patronising, alarmist rhetoric and more confronting the reasons many health problems are endemic. Patients are responsible for their own actions, but we can’t ignore the forces that mould how millions of people behave.  And the sooner we confront the painful, complicated truths about intersecting poverty, societal influences and human behaviour, the sooner we will stop seeking a panacea in simplistic shocks. We need to avoid patronising patients, or swamping them with scare stories. Yes, sometimes we will need to be firm, but it shouldn’t be our only, or most important weapon in the war against disease. No, the balance won’t be easy to strike, but nobody said medicine was easy.


[COMMENT] /13 Caring Cannot be a Competition

theMEDICALSTUDENT / November 2013

Comment Editor: Rob Cleaver

Richard Watkins Guest Writer Firstly, let me admit to you that I, Richard Watkins, am a competitive person. I am obsessed with my own potential for greatness and my willingness to succeed at almost any cost. I am not a competitive medical student, however. I cannot fathom the fools who so gladly gallivant through Wikipedia articles changing truths to half truths and half truths into lies. There’s nothing about caring that should be competitive. And yet it is so. Medical school is the most intoxicating environment for academic betterment; you learn something new, tell someone about it excitedly and then are usurped from your throne with a retort about a biochemical pathway that you’ve never come across before. There is always someone who is more knowledgable and there is always someone willing to go about displaying their plumage of paper authorships.

[My friends on other courses fare differently. There is a hive mind, a community of do-gooders wishing success on everybody. In medicine, assessments are lonely, personal wars] My friends on other courses fare differently. There is a hive mind, a community of do-gooders wishing success on everybody. In medicine, assessments are lonely, personal wars, interspersed with passive-aggressive battles for the computer closest to the library cafe, or the textbook you were meant to take out on loan all the way back in week one when you told yourself you would work harder this year. How do we think that this culture translates into a workplace dedicated to caring? How do we think the public would think if a face they thought was friendly was more interested in them as a statistic in a study, designed to deliver them a reputation? I know we are not alone as a career driven profession but I think we must single ourselves

out as the one that has competition as the antithesis of our purpose. Yes, it is important that we push the borders of modern medicine with new drugs and new treatments and new happy endings for the patients in the system, but should that come at the cost of our own working relationships? We are told from the very first few months of our degree that it is important to work as a team and we accept that other disciplines play as important a role in a successful patient journey as any doctor does but often we overlook the fact that doctors alone are a team too. In medical school therefore, it is in everybody’s interest to help out our fellow students when they are struggling because we want that team to be strong. You cannot do everything alone. Sometimes you have to cave in and sleep. Sometimes you have to give someone else a chance to continue your good work. What medical school needs is a culture of kinship. Yes, be ambitious and be industrious but remember that your friend is too and that those two brains are better than just one. Researchers always reflect that advancement comes as a result of teamwork. We each have our flaws and our kinks but we also have within us abilities that are useful and are essential. It is hardest of all to study yourself and know these things rather than to study the books alone. If you know your strengths and your flaws you can compensate for these with a team that have those weaknesses as strengths and visa versa. That is how successful studies come about and that is how that notoriety you constantly crave is gained. Can this ever happen though? No. We are told too readily that to get in here is a competition in itself and, after spending two years fighting with people we’ve never met for a place, we form friendships with them. We sub-consciously know that they will apply to the same posts at the same hospitals. Human beings are very good at keeping their friends close to their bosom but they are better still at clutching tightly to the coattails of their enemies, their competitors and their nemeses.

Dear Doctor..


ear doctor, I’ve just started med school and I was wondering what events I should go to in my first year? I’ve been thinking long and hard about this for some months now and I am really at a loss as to what to do. As soon as I got my A-Level results I went home and used my back-up revision timetable stash to draw out an hour by hour Freshers’ Opportunities Guide. I’m drawn most to the fair and the debate club and the opportunity to join the War Games society as well as the open position of President at the Freeform Jazz Ensemble. Do you know how to get hold of first term notes beforehand? Is there anything else in particular that you remember from your time as a student that you think I should take part in?


Verity Keane

reshers, freshers, freshers. As a doctor, I rarely see you lot nowadays - always in lectures and never here on the wards satisfying my inflated sense of self worth and self-appointed father figure status. You’re useless to me in terms of knowledge but you make me look so damned important that I can’t help but wish I had you here. I digress, come with me, pour yourself a glass of single malt and let me tell you of a time when I was young. You see how the whiskey moves out of the bottle into that tumbler? It is relaxed and it does it at its own pace and it is fine with that as am I. Each of these amber jewels in my cabinet has a unique

rate at which it welcomes a drinking vessel and, like them, you have to go with the flow - your own flow. There’s no point doing something that you don’t want to do but I suggest you take the plunge and dip your feet every once in a while. I went with the flow at freshers week and I segued from one drinking society to another, via the Woodwork Society and a Student Newspaper but the main thing was that I made friends and future colleagues. Yes, often these would become my nemeses but that is a lesson learned with time and competition for SHO roles in central London Hospitals. Don’t concern yourself with that though it is way above and beyond you. So smoke up, live the high life, do whatever gets your mojo going, just make sure you’re on the wards when I want you to be because I have a question I know that you haven’t got the answer to.


Dr. Ron Swanson

ear doctor, I have been exercising a lot recently, often spending sleepless nights in the gym so I am ready to flex my biceps in lecture theatres for the girls on the third row. The problem I have, however, is that this doesn’t seem to get me anywhere with the fairer sex. Yes, they sure do love the blue veins running down my guns like the Piccadilly Line beneath London - and I know because they look at me slack-jawed, but they don’t ever speak to me or approach me. Do you think that they may be intimidated by the fact that I just wear my work-out gear (Speedos) when I walk in eve-

Got a problem?

ry morning? Even the ‘Lads’ aren’t talking to me much any more! Do I need to get even bigger?


A Rugby Lad

ig daddy, I get the impression that you fancy yourself (in the mirror), as the kind of go-to-guy on campus who is almost certain to have a collection of whey protein barrels atop his fridge that are as much a badge of honour as they are a suffocation hazard for small children and animals. When you enter the lecture theatre you should abide by several rules so as to avoid detection by lecturers but encourage it from your fellow students. Nudity, for example attracts both and we do not think that a 9 a.m. start after Sports Night really requires the extra throbbing package that you offer on top of what a hangover has already willingly provided. I suggest that you do two things. First, wash after your work outs. That’s a given; it’s hygienic and just better, okay? Secondly, I think that you should try expanding your vocabulary in the language of love. It’s like normal english in all ways - it is normal english. Most importantly, don’t speak with your muscles. A takeaway piece of advice: A bulging bicep may look good but it’s not going to take you to Nando’s on an anniversary for a Lemon and Herb Half Chicken with a bottomless Coke Zero, is it? A six pack doesn’t feel anywhere near as good as chicken tastes. Dr. O. B. Seety

[EDUCATION] /14 Money matters as a student! theMEDICALSTUDENT / November 2013

Education Editor: Shivali Patel

you head towards the last few pounds of your student loans near the end of term. To achieve this, I have a few important words of advice:

Shivali Patel Education Editor Welcome freshers! I hope you’ve adjusted comfortably to university life and the new academic year by now. Hopefully, you are enjoying the life of a medical student and remain just as eager as you were on day one. If not, that’s a real shame and hopefully you’ll be attentive to what I have to say for the next few hundred words and will change your mind! I’m sure many of you have realised during your first few weeks that despite being in one of the most exciting cities with countless activities to take part in, residing in London isn’t cheap, especially when five long years must be sacrificed. Become spending savvy and you’ll have fewer worries as

1. If you have not done so already, invest in a student Oyster. These offer much needed discounts when traveling around the capital and you certainly won’t regret having one when voyaging to firms and placements (which literally can be miles away!). 2.

Be wise when choosing your student account and don’t be deceived by freebies. Choose the account that best suits your needs, so research the overdraft facilities, interest rates etc. If this will have little effect on you then think about the perks they are offering. Santander are offering a free railcard this year to anyone opening a student account

with them, which offers 1/3 of all fairs for four years.

3. Keep track of what you spend and be organised by budgeting wisely! You will repeatedly receive friendly advice about not squandering all your money in the first term and as tiring as this is to hear, it’s true. Make a plan before it’s too late and stick to it. Do try to strike the right balance too or you may just fall into a spending binge. If you can, pay by cash rather than card when shopping. This way you can keep track of your expenses much better and will have less of a surprise at the end of the month. 4.

Prioritise all the essential costs first. This includes rent, bills, food and then set a weekly cap for things like nights out and take-aways. Basic cooking may save some

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pounds too and home-made meals are much healthier if you use the right ingredients.

5. Look out for any discounts that may be available. NUS offer several for all types of purchases and there is even a smartphone app to inform you of these. It is your responsibility to check out offers and make note of any 2 for 1 meals, half price cinema tickets and even complementary services. You will be really grateful for all these. Remember to ask if the store offers student discounts each time you buy something. You’ll be surprised by the offers you miss. Studentbeans, vouchercloud and also have many generous discounts and give useful advice on being money- smart. 6. Utilise the study resources offered by your univer-

sity. Books are costly but are a valuable investment if the right one is bought. Usually those advised by your lecturer are the best as what you are taught is most likely to be based on these. If you feel you don’t need to use the book for more than a few months, then borrow one from the library. There is usually a competition for freshers to win books or stethoscopes. Apply. You might be lucky enough to win!

7. If you feel you can handle a part time job to help you cope with the costs of being a student then that may offer some more leeway with spending. Finally, remember to enjoy life as a student, as the years really do fly by. There will be tough times ahead . You may feel disgruntled and tired at times but the good times will outweigh these!

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theMEDICALSTUDENT / November 2013

Education Editor: Shivali Patel

Apps to Aid! Shivali Patel Education Editor In this growing digital age, smartphones have become an essential item to the medical student’s kit and if I may say, life! What is more, is that this 10 by 6 cm piece of electronic equipment is revolutionising how much we go online to look up the odd piece of information, when necessary. The once luxury of using a smartphone to look up what you need, where you want has become a natural reflex. Medical apps are becoming increasingly popular and they are a great tool for quick learning, especially on wards. The popularity of mobile apps has risen in recent years to such an extent that people now resort to using apps as opposed to browsing for information. There is now even a Doctor’s Note app to quickly create personalised return to work/school notes for patients. Many students are aware of the question bank apps offered by companies such as Pas Test or Passmedicine. These provide convenient, quick revision opportunities for students in between tasks. Different mobile operating systems offer a range of medical apps but many have similar and competitive purposes. There are a range of different types of medical apps the majority recommended for medical students are free of charge. Unfortunately, Pas Test,

Passmedicine and now BMJ onexamination all require a subscription fee for full access. A commonly used app during ward rounds and one definitely worth getting is the free BNF prescribing app which is available on the android and iPhone smartphones. Many medical students find this app useful as it provides information on the drug type, the dosages available, indications, contra-indications and the side effects, all of which can be accessed while on the move. Also, unlike many other apps, the internet is not required for access once downloaded and you save time by not needing to flick through the book. There are several apps offering medical knowledge which are worth having. Currently, Medscape is voted the best app for medical students in the United States and many British students find it beneficial too. The app is incredibly thorough and provides detailed information on diseases, including the pathophysiology, investigations and treatment. It also informs of medical procedures, medical calculations as well as hourly updates on the latest news within medicine. The information that is provided is always wellreferenced, with relevant journals and any conflicts of interest disclosed - making it definitely worth getting. However, one drawback is that as this app is American, so one ought to be cautious when searching drugs as different ones



Image courtesy of are usually prescribed in the UK. For those unable to access Medscape, if they are using an old Android should download Skyscape. Skyscape is a high-quality all-inone type app, which serves as a universal app for other apps providing access to medical calculators, medical news alerts, select practice guidelines, paid textbooks, Netters anatomy, drug references and disease monographs. It is unfortunate that very few medical apps that are well known are British, causing students to be cautious of the information they read about. BMJ have recently launched a similar app but is only available on iPad currently. Additional features it does offer are podcasts and easy to read one page summaries of research papers. Docphin is an upcoming highlyrated app to keep track of medical literature. As it is within hospitals

and institution libraries, there is no need to login in multiple times to obtain the articles you require, making it much quicker to access papers. Also, you can customise the website to inform you of medical journals and news stories of specialties that you are interested in. These articles can be marked favourite and stored in your profile, so can easily be accessed in the future. Unfortunately there is no app in the market which informs individuals of the normal range of test results. If such an app did exist, whereby blood results which were abnormal could be entered into a system and explanations for possible abnormalities were given, that could prove incredibly worthwhile, especially for those keen on unravelling the patients problem. Also Medibabble, an app that provides translated ques-

tions which are needed for taking a thorough clinical history and clinical examination from patients who are unable to speak English is useful for situations when a formal interpreter cannot be obtained. However, despite this app covering over 60 types of complaints across 11 organ systems, it only offers translations in 5 languages: Spanish, Cantonese, Mandarin, Russian, and Haitian Creole. More languages are necessary if it is to be implemented on a large scale, indicating another potential gap in the market that can be filled. So, there are so many apps to aid with learning and I have just covered a few of these. They are great for revision and checking up on knowledge but be cautious that the ones you download have the correct information. To avoid confusion always check references to ensure the source is reliable.

Why should meducation be done properly? Sil-Jun Lau Guest Writer We’ve all been there. The consultant, totally oblivious to the world, droning on about their speciality as if the knowledge they’ve accumulated over decades is common sense to us all. You sit their nodding your head rhythmically to fool everyone into thinking that you’re learning something. The hour’s teaching session is turned into a marathon effort to try and stay awake. Education is a fundamental pillar of any profession and without education, medicine would fall. The use of traditional and dogmatic methods which produce unproductive learning experiences is doing a disservice to both the student

and the profession. It is also a poor use of the doctor’s and student’s time – something which is increasingly difficult to find. And now, when the burden of paying for a medical education is shifting towards the individual, medical students rightly demand a good quality education. As a child moving schools my learning never became disorientated because I always found that my teachers used similar teaching methods. These methods are based upon educational theory and research and are taught to all teachers. Likewise there are many similarities in medical school curriculums (PBLs, etc.) because they all arise from the same pool of educational research. This all changes on the

ward however. The teaching provided by many clinicians is no longer based on current research and theory but on the individual and old-fashioned ideas which may not work very well. Medical students and doctors are not getting the best educational experience possible because their teachers are not equipped properly to be the best teachers. As a student I want my teachers to be the best that they can be. I want them to be familiar with the current thinking on education and the psychology of learning. A teacher wellversed in the theory and art of teaching could perhaps help me to become a better doctor. As a teacher I would want my students to gain as much as possible from me. And I would want to know that the teaching

methods I’m employing are effective. I think that learning how to teach is not emphasised enough in our medical curriculum or even in our profession. These days we teach each other how to be better communicators with techniques validated by research, yet we neglect to teach ourselves how to be better teachers. Our profession should emphasise the need to not only be the best doctor, scholar and scientist as is possible, but also the best educator too. To not do so would be to ignore the foundations of our profession. Medical schools have realised this and have begun to teach their students how to teach. But all too often the time spent on this only amounts to a few hours dur-

ing the final year. If this knowledge is not practiced and built upon it can be easily forgotten. Perhaps more importantly, doctors are not being taught to teach. The informal teaching they do every day on the wards is wasted because they are not employing effective techniques. What I have argued is not necessarily a no-brainer and there are many considerations to think about. How do we prevent the creativity and imagination from natural teachers being stifled, for example? How to implement this in real life is also another debate altogether. I simply wanted to start a conversation about our education. And I wanted to ask whether we are becoming the best teachers that we can possibly be?


theMEDICALSTUDENT / November 2013 Culture Editor: John Park

It’s better up there Chetan Khatri Writer South African filmmaker Neill Blomkamps’ Elysium, has come as his latest production since District 9. After receiving four Oscar nominations for District 9, as well as a roaring financial success of returning seven times more than production cost, many considered Blomkamp to follow Christopher Nolan once he had the full support of Hollywood’s full personnel. Set in the year 2154, when “Earth was diseased, polluted and vastly overpopulated” the picture is set in a ruined megaslum of a future Los Angeles. Populated by a lower class Latino majority, the city is policed by uncompassionate robots,

whilst the population slave in substandard factories ironically producing the very droids that inflict their misery. Whilst the citizens of Earth rot, the rich superclass have emigrated to Elysium: an outerspace gated community full of mansions and preserved gardens. Elysium is guarded by Delacourt (Jodie Foster), a ruthless, icy

guardian. Sporting a mean British accent she swiftly changes to fluent French when endearing with her husband and children in an ultimate haute-bourgeois display of heartlessness. Blomkamp, originally South African, frequently visits his native country and recalls the discrepancy of the have and have-

nots to drive his filmmaking. It’s certainly seen in Elysium, with Earth dirty and broken, Elysium is clean, glittery and immaculate. It is emphasised even further by rough, hand-held camera footage on Earth compared to Elysium, where the camera glides slowly and smoothly. These favoured few live in this utopia without any harm, each house having their own universal panacea ‘fix-all’ machines. After our hero Max (Matt Damon), a blue-collared worker who after receiving a fatal dose of radiation in an industrial accident, decides to fly to Elysium in the hope of curing himself. To stop him, we have Kruger (Sharlto Copley), a South-African mercenary left behind on Earth to enjoy his sadistic

behaviour. I find myself wanting to know more about Elysium, how it runs on a day-to-day basis. Instead we are offered a clobbering between Max and Kruger for the last third of the film, a macho face-off that could come from any film. Although at one stage this is all I would ever want from a film, I found myself looking around the theatre, bored of an uninspired fight sequence, to see almost the entire cinema either asleep or on their smart-phones. It’s not much of a spoiler to tell you all of Earth’s population is saved with the incredible cure-alls, a shame in my opinion. What happened to an older pessimistic outlook? They weren’t as cheerful, but they were a little more realistic.

Harvey - are delusions really bad? Zara Zeb Doctors’ Mess Editor Although set in the 1950s and classed as comedy, Harvey touches on a rather profound question. If a delusion makes someone a better person as well as happy, do we have any right to remove their delusion? A black-and-white movie, Harvey focusses on Elwood, a middle-aged guy whose best friend is an invisible 6-foot rabbit called Harvey. Elwood’s family are ashamed of his delusion and decide it is time to have him locked up in the sanatorium. Confusion and hilarity ensues as Elwood is mistakenly released and his sister who went to lock him up is committed. As doctors and police chase over town looking for Elwood, we follow Elwood as he encounters strangers and old friends alike. Calm, jolly, friendly, and always up for a drink, Elwood makes a positive impression on everyone he meets, brightening their day. This movie makes you question whether someone such as Elwood is really to be feared,

treated, or accepted. Although the viewer never sees Harvey, we see how Elwood loves his best friend; making sure people don’t sit on Harvey, including him in conversation and buying him drinks. This leaves Elwood vulnerable to being used, such as a fellow at the bar who says “the one at the end of the bar will pay for” his drink, with Elwood happily obliging, saying Harvey would be more than happy to. Society is also aghast at the mention of an invisible being and scurry away from Elwood as though he was a danger. But there is more to Elwood than seeing tall rabbits. Elwood has his wits about him as he sets

up two characters who obviously needed that extra push to make them realise their love. Although medically we briefly touch on what happens in a sanatorium – the flirting between doctors and nurses, minimal patient involvement in their care, and rash diagnoses made without seeing the patient – we never conclusively know where Harvey came from. Harvey is thought to be created as a result of Elwood’s excessive drinking following the loss of his mother but this is never explored in depth. We also hear how Harvey has made Elwood a better person. Before Harvey, Elwood is described by his family as being

miserly and bitter, and now he’s a transformed person. Towards the end of the movie, one of the doctors not only indulges Elwood’s delusion but falls into it himself. Where should the line be drawn between accepting and endorsing? Should we as future doctors or as a society indulge the likes of Elwood or do they need to be brought back to a harsh reality that would leave them bitter? Despite the many questions this movie throws up about our perception of patients with mental health, it is by no means to be taken seriously. A light-hearted, comic movie that will have you laughing throughout.


theMEDICALSTUDENT / November 2013 Culture Editor: John Park

And they’re

John Park Culture Editor It’s a shame there’s so much controversy surrounding this year’s Palme d’Or winner, Blue is the Warmest Colour, that could potentially act as a deterrent to a film which is clearly not an instant easy-sell. Running for three hours, Abdellatif Kechiche’s La Vie d’Adèle (original title), does exactly what it says on the tin. We follow the life of Adèle (Adèle Exarchopoulos, in a note-perfect debut performance - but more about that later) over many years as she progresses from an experimenting high school student to a young woman trying to find her way in life. First, the controversy: since there is so much negative buzz going around, it’s difficult to know where to start. The graphic content is certainly worth mentioning. The film consists the most frank depiction of sex and nudity you’ll ever see in a non-pornographic, general-release movie. The NC-17, 18 ratings this has been slapped

on with have all been placed for a reason, and this isn’t one to watch with your parents. And yes, these scenes do go on for quite a while, and there are lots of them. For those who can’t stomach content like this, it would be simply best to avoid full-stop. Then there’s the series of complaints that has been made against the director, for creating a hostile working environment, with the two lead actresses going so far as to state that they will never work with him ever again. Even with these harsh words, what the audience should ultimately be interested in is the final product, which is simply a mesmerising piece of storytelling. The general arc of the film’s plot deals with nothing inherently new. It’s a coming-of-age story that starts with a 17-year-old Adele who dreams of being a teacher. Her first sexual encounter, one of many explicit scenes to come, is with a similar-aged boy (Jérémie Laheurte), who doesn’t quite hit all the right spots. This all changes as she ventures out into a lesbian

bar where she meets the bluehaired Emma (Léa Seydoux). As a fine arts student, Emma is strongwilled and confident, and introduces Adèle to a whole new experience of desire and lust. Everything seems peachy, but problems arise as years go by, and staying fully committed doesn’t appear as easy as it first seemed, where insecurities, loneliness, as well as timely temptation presented from the outside world take up space in their long-term relationship. Kechiche’s structure is familiar in set-up for sure (the ups and downs of a romantic relationship), but completely unique in its style and depth. Here is an intimate expose of what feels like a perfectly plausible relationship in life. At no point does the film require us to stretch our imagination, as everything is quite plainly spelt out for the audience. We follow them, almost in a documentary style, and it’s not just a glimpse we gain, it’s the whole picture. So yes, it does run for three hours, but as the late Roger Ebert once said, “no good

movie is too long” and here is a fine example of such excellence. The hours fly by in the characters’ natural conversations and easy chemistry, and I could easily have sat through another three-hour chunk. That the characters are lesbians plays a certain part in drawing the two leads out, but is not the sole focus of the story. Yes the two women go on gay pride rallies, there are the aforementioned scenes of graphic sex, and as it so happens, there is a hint of discrimination and perhaps a sign of Adèle’s own personal shame associated with her sexuality and not quite fitting in with the social norm. But instead of going down the preachy route of heavy-handed narrative, the homosexual aspect of the plot remains largely incidental. This isn’t a lesbian love story. This is a love story of two people who share mutual attraction. So for example, Adèle doesn’t become a pioneering figure in advocating gay rights. She is happy in her school teaching her classroom full of adorable young kids, a dream

she’s had since adolescence. Most compelling are the two performances from Exarchopoulos and Seydoux who were awarded the much-coveted Palme d’Or of the 2013 Cannes Film Festival along with the film’s director, an unprecedented reward that they thoroughly and richly deserve. Exarchopoulos, in her debut is simply fascinating to watch. What she does even with a simple movement in her eyes conveys so much, and as she tears up for the more dramatic moments of the film, she is an absolute force of nature in every frame she’s in for the film’s lengthy running time. Equally strong as her counterpart is Seydoux, naturally charismatic and confident as usual, with or without the striking blue hair she rocks. Together they laugh, cry, scream, make love before our very eyes. And it’s in the film’s raw, intensely passionate moments Kechiche reaches completely new heights in what started off as an ordinary love story. For those who aren’t fazed by the content, this is one to definitely seek out.


theMEDICALSTUDENT / November 2013 Culture Editor: John Park

Cutting for Stone - Abraham Verghese Zara Zeb Doctors’ Mess Editor Abraham Verghese started his medical training in his home country, Ethiopia, but completed it in India due to civil unrest in his homeland. He went on to practise in the States and discusses many medical diseases in his novel, Cutting for Stone. Just as he is a renowned physician, Verghese is a talented author. His story is set mainly in Ethiopia where conjoined twins are born to a nun and a surgeon. The mother dies during childbirth and the surgeon abandons them in his misery. The twins, Marion and Shiva

(separated after birth), are raised by a pair of doctors, with both brothers entering the medical profession. As they grow older, Shiva and Marion begin their separate journeys in life, often clashing. The reader follows Marion as he is betrayed by Shiva in his first love, is forced to flee from Ethiopia and finds his father in the States. Throughout this cleverly interwoven story, the reader experiences Ethiopian tradition, as well as the confusion between Marion and Shiva’s parents as to their love for one another. For the more medically minded, this book portrays the reality of under-resourced hospitals, female genital mutilation, and the disparity in care around

the world. Many conditions such as birth-related fistulas, common and tropical diseases, and surgical procedures are often mentioned in detail. Verghese’s main message throughout the whole book is empathy. Characters are repeatedly recounted the most important question “What treatment in an emergency is administered by ear?” to which the answer is “words of comfort”. This profound message shared in a touching way will hopefully inspire and shape how any medical reader treats their patients. An absorbing read for the rare book that combines medicine and fiction in a cleverly woven journey.

Still Life - ICSM Drama Production Chetan Khatri Writer This year ICSM drama’s one-week play was a production of the short play: Still Life. It was originally written by Noël Coward as part of ten plays that make up the Tonight at 8:30 series, intended to be performed over three evenings. The play follows the tale of Dr. Alec Harvey (Elvin Chang), a married physician and his chance meeting with Laura Jesson (Abi Squire), a housewife who has just finished her shopping chores. Set in the waiting lounge of Milford train station, we find Laura in pain with a piece of grit in her eye leading to a gentlemanly Dr. Harvey removing it for her. As the months

progress, they meet more at the station, slowly falling in love with each other. Their serious and secretive affair is quite convincingly portrayed by the two leads. Abi Squire is able to change from an exciting character to one that is torn between differing emotions of guilt and pleasure at their secret affair. Elvin Chang is able to place a realistically strong British accent, over his usual empowering Canadian natural, and playing his role as a polite, British physician very well. As their relationship develops we have the parallel, animated and, at times, comical relationship growing between the station staff of Myrtle Bagot (Fiona Seabrook) and Albert Godby (Matt Leahy). As Mrytle commands her employ-

ees of Stanley (Jack Hardling) and Beryl (Samantha Thalayasingam) we see another small romance develop on the side lines. A commendable mention should also go to Rachael Aldersley who injects some energy into the final moments of an otherwise serious performance. Playing the role of Dolly Messiters, she very quickly arrives as a loud, boisterous and quite annoying character, spoiling the final meeting between our two leads. The play also sees a short cameo appearance of our own Rhys Davies, playing the blue-collar worker Bill. Overall the directors (Aarohi Shah and Fiona Seabrook) provided a great hour of entertainment, and should be highly commended.


theMEDICALSTUDENT / November 2013 Culture Editor: John Park

“Everything you because of that butler” John Park Culture Editor When his mother is raped and father murdered by a nasty white man (Alex Pettyfer - very convincingly fitting), Cecil Gaines is taken in by an elderly plantation owner (Vanessa Redgrave) to work as a house servant. The skills he acquires here serves him well in the long run, as he goes on to work not only in a fancy posh hotel, but he makes it all the way to the White House, serving under numerous Presidents of the United States over several decades. The Butler, an American sleeperhit over the summer that finally reaches the British screens in November, is based on the true story of Eugene Allen, who worked in the White House for 34 years until his retirement in 1986. Throughout his dedicated career he is the firsthand witness to the American Civil Rights movement, with significant events involving racial issues becoming a huge part of his life. This dramatisation looks at Cecil’s life, both the professional and personal sides, although rather fleetingly, focusing on the landmark events that changed the course of American history. As an adult, Cecil (Forest Whitaker) is a married family man with children. His wife Gloria (Oprah Winfrey) is mighty proud of her husband’s accomplishments, although as time passes by, his complete dedication to the job forces him to give up on some valuable family time. His two sons grow up to be very different individuals. His eldest Louis (David Oyelowo) is the more volatile, hottempered one, fighting for equality for the black Americans who

face unfair treatment every day. He disapproves of the country he lives in, and this disdain and hatred soon turns to the White House itself, failing to respect the work that his father does, something he sees as blindly following orders from white men who don’t give a damn. The youngest, Charlie (Elijah Kelley), has virtually no source of potential conflict, which is why we see more of Louis and his relationship with Cecil that falls apart before our very eyes. Inside the White House, Cecil quickly rises in the ranks, working in close quarters with the Presidents. Dwight Eisenhower (Robin Williams) actively campaigns for integrated schools that will no longer discriminate based on race, John F. Kennedy (James Marsden) is sympathetic to the AfricanAmericans’ cause and their freedom riding movement, Lyndon B. Johnson (Liev Schreiber) fills in after Kennedy’s assassination, Richard Nixon (John Cusack) takes firm action against the aggressive

Black Panthers, and eventually Cecil is invited to attend the State Dinner by Ronald (Alan Rickman) and Nancy Reagan (Jane Fonda). Big famous names, big famous parts, and yet the roles of the many political figures are minuscule at best, and they all disappointingly speak very little, a few lines of dialogue, before they’re forgotten and never heard from again. The Butler gives very few quick snapshots of what is happening in America before quickly moving on to the next President, where Cecil and Gloria are noticeably older, with a fresh set of problems for them to face as a family. It’s certainly very informative, especially for those not familiar with this specific part of the history, highlighting the key events under each Presidency, the structure of the film is at risk of becoming too episodic, with very little linear narrative holding everything together. But it’s the outstanding cast that truly makes this all worthwhile. Whitaker is sensational as Cecil,

humble, restrained, and yet a highly intelligent and dignified man. Building from his traumatic childhood, Cecil wants what is best for his family, and putting everything he knows to good use (i.e. serving) and he has certainly done well for himself. He respects the uniform he wears, and though he may not agree with all the Presidents he serves, he certainly respects them too. This steadfast loyalty shows in Whitaker’s nuanced, quitely sustained performance over the twohour long running time, and he is simply a joy to watch. Winfrey, making a welcome comeback to the movie screens, is also in a role of a lifetime. She’s the long-suffering wife, as she fights alcoholism, loneliness as well as trying to desperately hold on to the family peace once the patriarch and the son start having their problems. She has much warmth in her performance, but when it comes to speaking up, she’s not afraid to raise her stern voice. “Everything you are, and everything you have,

is because of that butler” she says, after giving her disrespectful son Louis a big backhand slap, in what is no doubt the film’s highlight. Whitaker and Winfrey should surely be in for some award nominations, and perhaps if things go the right way for The Butler, Oyelowo might also have a shot in the race too. A brave but often naive and rash is his young mind’s thinking process, not able to accept the discrimination his race faces, his steely-eyed determination is one that injects passion, however misguided, to the story. Given all the inequality and injustice he’s seen and experienced, the film’s final moment of Barack Obama’s inauguration, and Cecil’s witnessing of that huge milestone of a moment speaks loudly for anyone who has been truly invested in Cecil’s life - which will be many, as The Butler, despite its shortcomings, does live up to the powerful message it wants to convey. It’s a film full of ambitions, one that achieves most of its goals.


theMEDICALSTUDENT / November 2013 Culture Editor: John Park

Breaking Bad: The Potential of the Medium of Television Realised? Christopher Holland Guest Writer “Chemistry is the study of matter, but I prefer to see it as the study of change”. By speaking these words, way back in the pilot episode, Walter White himself summed up one of the main themes of this series: his own transformation For anybody who has somehow not watched this outstanding series, Breaking Bad is a drama series created by Vince Gilligan starring Bryan Cranston as Walter White, an absurdly overqualified high-school chemistry teacher who, after being diagnosed with late-stage lung cancer, decides to cook premium quality crystal meth with his former student Jesse Pinkman (Aaron Paul). Sounds a bit far-fetched? Perhaps, but it soon becomes so much more than this sentence-

long premise might indicate. By daring to change the charactors, not just as a tack-on to stop a series from becoming monotonous and predictable, but as a central tenant of the show, creator Vince Gilligan showed us a new use of the medium of television. Unlike films, which have a set duration, a key aim in television is often to remain on air as long as possible. As such, it is often victim to writers sticking with what works, and therefore going for long periods with little change, with sudden drastic changes to keep the audiences from getting bored. This is not conducive to seeing a gradual and believable change in a character’s personality. But Breaking Bad went there, taking the chance that the audience would invest in this show that by necessity was itself always changing and evolving. And by using television rather

than film, the character study could be conducted over a far longer timeframe, making it all the more fascinating. It was helped by outstanding acting, particularly from the two leads, Bryan Cranston and Aaron Paul and excellent structuring that ensured that, in a rarity for a multi-season series, there was never a major narrative misstep. The series may start slowly and be a little difficult to get into, it all serves to establish a solid foundation that allows it to engage in some great moments and suspense arguably unmatched in television history in later series. But I feel it is the character evolution, not only of Walter White but the majority of the principal cast, that sets this series apart. I genuinely hope that this provides a template for television drama for years to come.

Don Quixote - Royal Opera House Sara Tho-Calvi Guest Writer In his debut ballet as a choreographer, Cuban ballet maestro Carlos Acosta sets the stage alight with raucous clapping, clicking and cheering in a production which transports you back to Seventeenth Century Spain. Don Quixote tells the story of the seductively beautiful Kitri (Marianella Nunez) and the attempts of her potential suitors to court her. The first is the ever charming Basilio (Carlos Acosta), a barber, who is faced with the disapproval of Kitri’s father, Lorenzo. Next is Soho’s answer to Captain Hook, Gamache; and last is Don Quixote himself who believes that Kitri is the human incarnation of his ghost bride fantasy, reminiscent of Tim Burton’s films. The Spanish theme is prominent throughout with

the ruby red and golden-clad toreadors swirling their capes, the flamenco influences running through the classical ballet choreography and the unmistakeable sound of the castanets accentuating Ludwig Minkus’ uplifting music. The guitar-playing around the campfire is emotionally powerful, sending the audience into a quasi-trance, while the sultry gypsy women and their pirate-esque male companions gather to perform a passionate dance. In Act II is a dreamy scene from Don Quixote’s vivid and slightly overactive imagination. The audience is immersed in the land of the fairies where the dancers are enrobed in the most decadent, yet highly elegant, costumes the world of ballet can offer. The poise and precision of the ballerinas show us the true discipline of this skilled art form, and their perfect synchronicity makes

the whole scene a mesmerising visual feast. Four male dancers provide injections of humour into the ballet, and Don Quixote’s trusty horse is a design masterpiece looking somewhat like Joey from War Horse; however, here it is made with straw. As featured in many traditional ballets, the final act is one of celebration, a wedding, which showcases the principal dancers in pas-de-deux and solo pieces. As expected, Acosta and Nunez danced to rapturous applause, a testament to the skill of this highly respected and accomplished couple. Doubts are often held by the sceptics amongst us when a well-established figure embarks on a new venture, but Acosta certainly did not disappoint as a choreographer. I eagerly await to see where his next endeavours lead him.

Image: Johan Persson

The Doctors’ Mess

Did you know..? Guy’s and St Thomas’ Hospitals in Waterloo are the only designated national service for xeroderma pigmentosum (XP) . XP is an autosomal recessive genetic disorder affecting all ethnic groups. It is rare with an occurence of 1 case in every 250 000 people in the UK population. Around 50% of XP patients present with photosensitivity, burning easily after sun exposure. There is a high incidence of skin cancer in XP patients with the median age of 8 years.

Other skin related symptoms include xerosis (dry skin) and irregular patches of hyperand hypo- pigmentation. Patients are also photophobic, with UV damage leading to conjunctival inflammation and keratitis (cornea inflammation). Around 30% of patients also have neurological manifestations ranging from mild to severe. Possible features include hyporeflexia, sensorineural hearing loss, poor co-ordination, seizures or intellectual impairment.

Neurological manifestations seem to be unrelated to UV exposure. XP with severe neurological involvement is known as De Sanctis-Cacchione syndrome. Diagnosis is confirmed by skin biopsy. There is no specific treatment for XP, but management is crucial in preventing damage. Management includes avoiding UV light by covering the skin completely if outdoors during the day. Windows need to be covered with protective filters and

light bulbs indoors need to be UV fre. The patient needs to see a dermatologist every three months to rule out skin cancer; an opthalmologist annually; regular reviews for neurological development and surgical intervention for skin lesions. They will need to take vitamin D supplements, creams for their skin, artificial tears, and possibly other drugs which have had some success in trials. They may also wish to seek genetic counselling when con-

sidering having offspring. A normal lifespan is possible if XP is mild with no neurological problems and the patient has full protection from UV light. Specialists in neurology, psychology, opthalmology, and many other areas team up with neurogentics department at University College Hospital to form the XP multi-disciplinary team at Guy’s and St Thomas’. Nurses are also sent to the patient’s home, school or workplace to help protect patients.

History Corner - ST GEORGE’S UNIVERSITY OF LONDON Ashra Omr, Guest Writer 1733: St George’s Hospital was newly opened in Lanesborough House at Hyde Park Corner. It was built with three floors to accommodate 30 patients in two wards. 1744: The hospital underwent extension until it consisted of 15 wards for more than 250 patients. 1751: Apprentice doctors were formally registered. 1844: A brand new hospital, which was designed by William Wilkins, was completed over the span of 17 years. 1859: A new convalescent Atkinson Morley hospital was opened in Wimbledon. Named after a former medical student, the hospital aimed to provide a home for patients recovering from treatment at St George’s Hospital. 1868: The Medical School (in Kinnerton Street) was incorporated into the hospital. 1948: Along with the introduction of the NHS, plans to rebuild St George’s at The Grove Fever and Foundation Hospitals at Tooting were approved.

1954: St George’s began its first clinical teaching in Tooting. 1973: Building on the new site was in progress with two additional wings in the new hospital, which today provide a total of 710 beds. 1976: The new Medical School finally opened in Tooting and 4 years later saw the closure of the hospital at Hyde Park Corner. 2000: Saw the introduction of the MBBS Graduate Entry Programme (GEP), a four-yearfast-track medical degree open to all graduates. 2004: The new wing of the hospital was completed where the Trust’s cardiothoracic and neurosciences departments were situated. Additionally, Atkinson Morley Hospital was moved to Tooting from Wimbledon. 2005: St George’s Hospital Medical School was renamed St George’s, University of London. Today, St George’s, University of London is combined with St George’s Healthcare NHS Trust, one of the UK’s largest teaching hospitals. Although

we are relatively small school in terms of students, we have been able to develop a great sense of community amongst ourselves. One of the greatest benefits of St George’s is being able wander around from the lecture rooms to the wards in a matter of minutes. St George’s is known for its innovative academic and research projects, with recent in-

terests in clinical genetics, drug resistance, and the understanding of public health and epidemiology. As a medical school, we receive a large amount of clinical exposure to equip us with vital skills for the future. This is taught alongside a patient-focused approach to enable us to graduate as credible and competent doctors.

Prize Crossword Complications of Myocardial Infarction


theMEDICALSTUDENT / November 2013 Doctors’ Mess Editor: Zara Zeb

Are you a product of your partying, sports, or being wonder woman/man juggling medical school? extra-curriculars with work Fresh faced and eager, as and with uni. Why? a fresher full of wonder, you Why are you running had high hopes for the career you were embarking on. around filling up your diaries with commitments? Do you One/two/three/four/five/ six/etc years later, where enjoy them? Will they make has the wonder gone? Yes you a better doctor? Is it what the body is still amazing, but you want from life? you have become used to Why do we as medical stufacts being heaped into your brains. Where has the ques- dents think we’ll have all the tion “why?” which floated time in the world to do the endlessly in your head gone? things we really want after we’ve qualified, when life is Time is eaten up by your happening to us right now? medical studies, and all your Yes you only live one, yes spare time is taken up with recuperation in the form of you should seize the day, but TV marathons, Facebook, sometimes that means empty-

ing your life of all needless commitments and doing what you want to get the most out of your life.

Comic Strips 13 Emergency condition in which heart muscle ruptures (7, 9) 14 Cardiac arrhythmia few hours after infarction requiring immediate defibrillation (11, 12) Down 2 Autoimmune condition in response to damaged cardiac muscle weeks or months later (9, 8) 3 Ventricular arrhythmia in which a permanent pacemaker is required (8, 5, 5) 4 Arrhythmia in which heart rate is greater than 120 beats per minute (11, 11) 5 Complication occurring within 2 to 3 days in which patient experiences sharp chest pain enhanced by movement and respiration (12) 9 Ischaemic disease of non-infarcted myocardium with intermittent chest pain (6)

Diagnostic Corner 1. An obese 74 year old male presents with jaundice.On examination, the gall bladder is palpable. There is no history of abdominal pain. Why is the diagnosis NOT gallstones? • • •

Congratulations to Emira Muhammad from Barts and the London School of Medicine and Dentistry for winning our Prize Crossword: Complications of diabetes Mellitus in our Freshers’ issue! For your chance to win a copy of Interpreting Chest XRays provided by Scion Publishing Ltd, simply send a photo of your completed crossword to

a) Gallstones always present with vomiting and nausea along with intense pains in the abdomen b) Painless jaundice with a palpable gall bladder is unlikely to be gallstones because a distended gallbladder suggests a more acute obstruction c) The distended gall bladder is not the primary cause of the patients jaundice.

2. He tells you he drinks 50 units of alcohol a week. His blood results show alk phos, bilirubin and GGT to be more than double the normal readings. What is the most likely diagnosis? • • •

a) Alcoholic hepatitis b) Primary biliary cirrhosis c) Pancreatic cancer Answers: 1 b. 2 c.

Across 1 Appears within the first few weeks after MI and loud pansystolic murmur detected (11, 6, 6) 6 Late complication with persistent ST elevation and characteristic bulge seen on an X-ray usually after a large infarction (11, 8) 7 Complication with signs of over 50% crepitations over the lung fields (9, 6) 8 Complication associated with a hypercoaguable state affecting the lower limb (4, 4, 10) 10 Symptom associated with acute inferior wall infarction and treated with intravenous atropine (5, 11) 11 Post-MI complication due to papillary muscle dysfunction (6, 13) 12 Complication of myocardial infarction with a particularly poor prognosis (11, 5)

Questions adopted from


theMEDICALSTUDENT / November 2013 Sports Editor: Mitul Patel


Thin RUMS Squad Go Close in UH 7s Final Jack Smith Jacob Wilson Guest Writers The annual UH 7s rugby tournament returned for its 2013 instalment at Guy’s Hospital Athletic Ground on Sunday 6th October. As is tradition for RUMS, who last won the tournament in 2010, many players were unavailable for the day’s play. However, they still managed to field two sides- albeit composed mainly of forwards, freshers and the occasional back! This contrasted to the other sides who were fully stocked with sevens specialists and even a few illustrious doctors. Eventually, the first game kicked off between RUMS 1s and Barts 2s. Naturally, RUMS started sluggishly, with Bart’s scoring the first try within seconds of kick-off. However, superior ball skills allowed sustained possession and kept the scoreboard ticking over for RUMS throughout the remainder of the match, culminating in a fine opening victory. Facing a sterner test in their second game, the 1s raced to an early 15-0 lead against ICSM 1s; a bit of a shock for everyone. Trailing at half-time appeared to shock ICSM into action, and they were forced

into rotating their strong squad in order to keep legs fresh (and expensive shirts clean!), against a resilient RUMS cohort. As may have been expected, ICSMs superior depth and fine ball handling eventually paid dividends as the match finished with a 1715 defeat for RUMS. Kick-off in the third game against Georges favoured RUMS on this occasion, as the beautifully kicked ball was reclaimed and some tidy passing saw the 1s touch down instantly. Exceptional defensive organization had played a pivotal role in RUMS success and this match was no exception. Organized line speed along with excellent communication forced Georges into a number of errors which were capitalized upon. RUMS beat the opposition 17-15 and stormed into the semi finals. Whilst the 1s took hold of their group, the Boars (RUMS 2s) campaign was also under way. Pacey, champagne rugby was the defining philosophy of this brave team. Passing and offloading dominated their play and only very, very rarely was the driving maul put into practice. Commitment to this risqué

RUMS break through ICSM in the final. Picture courtesy of Vernon McGeoch rugby that proved to be the Boars’ downfall, as all games ended in defeat. They left the tournament with their heads held high, knowing they had not sullied the game by searching for contact or the biggest bosh at every opportunity. With the Boars out, the remaining hopes rested on the 1s shoulders as they faced the hosts, Barts, in the semi final. Injuries were becoming a real problem for the small RUMS squad. Despite this, fine run-

ning rugby was displayed by both sides along with the occasional big hit. This resulted in a score of 26 a piece as the final whistle went. In extra time, RUMS ran in two unanswered tries to propel themselves into the final. Matches had been coming thick and fast all day as the final against ICSM 1s loomed. The once determined and organised RUMS defense ran dogged in face of the fresher legs of ICSM. Cut down to six

players following a yellow card, RUMS fought valiantly despite ICSM running in a number of well worked tries. Kindly, the referee did not bin a second player following an offence 5m from the try line, yet this provided little relief as ICSM kept up the assault. RUMS did answer with a single try, but ICSMs 7 scores meant they took home the trophy.

UH Sports Night Returns Elisabeth Kostov Kalon Hewage Guest Writers Right To Play (RTP) is a global organisation that uses the power of play to educate and empower children facing adversity. Through sports and games, RTP operates programmes in more than 20 countries worldwide to help children build essential life skills and better futures, while driving social change in their communities with lasting impact. RTP also works in a humanitarian context during times of disaster or crisis. Imperial RTP raised a total of £6,725.57 last year, allowing us to reach 224 more chil-

dren, who, through weekly sport and play programmes, will learn, develop, and play; driving lasting social change in their communities and fostering the hope that is essential for them to make brighter futures. Last year’s UH sports night brought together over 700 students and raised over £4000 for the charity. This year’s edition is on 13th November, culminating at Disco Inferno on Clapham High Street Make sure you e-mail (imperialrighttoplay@gmail. com) to secure places for your sports club! We look forward to working with all of UH to make this year’s even better than last.

[SPORT] /24

theMEDICALSTUDENT / November 2013 Sports Editor: Mitul Patel

UH Tennis Year Ends in Farce Anonymous Guest Writer

UH Tennis’ 126th year of competition came to an end this month at the AGM held at The All England Lawn Tennis Club in Wimbledon. It has been one of the most controversial years for the organisation following a series of events that culminated in the mens’ league being declared a non-result. Such contention has come as a great disappointment to all involved and it has brought about drastic reforms of league rules to avoid a repeat incident. In this Medical Student exclusive, our reporter has quizzed all involved to get to the bottom of the issues that occured this year. This article was opposed by all members of ICSM Tennis Club, who wished to have it recorded that despite their grievance with this year’s running of the mens’ league they have accepted the decision imposed by the committee. The season started off with ICSM dominating the MPS Mixed Doubles tournament. Of the eight quarter finalists, five were from ICSM and from here it appeared that the only remaining question was whether it would be an all Imperial final. However the draw did not permit a ‘west london derby’ and eventually the pair of Adam Gunasekara and Pauline Schelbrook won the day, defeating the St. George’s pair of Joe Clarke and Hannah Kirk in the final. The summer session of tennis got underway with the first round of mens’ and mixed matches. These weekly fixtures, which pit the best of each medical school against each other,

took place over the following month with tight matches in most games. Coupled with these matches was the ongoing UH fixture list, where a combined team from the constituent schools in London takes on some of the most historic institutions in the world of tennis. Unfortuantely for London’s medical elite, a trouncing was served up from the perennially strong Cambridge university side. A break in fixtures allowed for the commencement of the summer inter-UH leagues and this is where our reporter has delved into the gritty details to bring the students the truth behind the situation. As the final day for league matches came and went, Barts were left topping the table in the mens, with ICSM second, and the reverse order in the mixed. This offered an exciting prospect for finals day for both medical schools, where the UH champions are declared following a match between the top two placed teams in the league. Barts put up a great effort and, despite strong support, were unable to overcome two strong ICSM teams. The final score was 9-0 to Imperial in the mens’ and 8-1 in the mixed, meaning ICSM had taken all three UH titles for the third year in succession.The UH summer did not end at this stage though. After a summer of silence, the captain of RUMS mens’ team lodged a complaint with the UH committee in which he staged a personal attack on the captain of UH; a student at Imperial. Claims were made that there had been a conspiracy against RUMS and they should be reinstated in the final. This all came despite the

fact that by the date that the league rules had stated all matches must have been played by, RUMS had only played two matches; winning one and losing one. Prior to the seasons close, RUMS twice cancelled on the morning of scheduled matches, allegedly because their strongest team was not available. In addition, they did not meet the league deadline date, despite being given four months notice to play four matches. After much deliberation, with cases put forward from all sides of the argument, a decision was reached to declare the mens’ league to be void, stripping ICSM of the

men’s title and leaving them with the remaining two UH titles in 2013. Thus it is left to Usain Bolt to achieve the elusive ‘treble treble’ in Rio 2016. The UH season continued on despite this controversy with a mixed match at the prestigious All England Lawn Tennis Club only a week after the historical victory by Andy Murray at The Championships. In fact he was on site to witness the high level of tennis on display from Professor Mortimer’s presidents team as they beat the UH team. Desperate for the first win of the summer the UH mixed team took on the

Army’s ladies team and secured a victory in what UH hope will become an annual event. After the disappointing culmination of the men’s league in 2013, all members at UH Tennis are desperate to avoid a repeat situation. Following the AGM on the 9th October, ICSM have taken three of the four positions on the UH Tennis committee and will push for more involvement from all sides across the year. They have stated that they believe the main force behind UH should be cooperation and sportsmanship between all the medical schools.

Mixed Start for GKT Footballers Jonathan Thrirunavugarasu Guest Writer

GKT football club have high hopes for the 2013-14 seasons, having come off the back of an exceptional campaign last year, where each of the five teams won at least one trophy. The season began with trials day, where hundreds of eager freshers, some more hungover than others, were put through their paces by venerable Seniors. This writer has never attended a cattle auction, but freshers’ trials is probably what he would imagine it is like. The first set of matches kicked off with the hotly anticipated GKT-KCL Challenge Cup, where the five GKT teams spar against their KCL rival team numbers. Unfortunately GKT lost three games to two, but captains were encouraged by levels of performance at this early stage of the season.

October fixtures in both the BUCS and LUSL leagues followed. The 1s thrashed Imperial 2s 6-1, a result that leaves them joint top of the LUSL premier division, and the 2s defeated King’s 2s 4-1; both excellent results following opening defeats to St Marys’ 2s and Kingston 2s respectively. GKT 3s overcame Goldsmiths 3s 4-1 at home to sit on top of the LUSL 3rd division at this early stage. The 4s also won, dishing out a 2-0 defeat to King’s 5s, to sit 4th in the fourth division. Sadly, the 5s were on the wrong side of an eight goal thriller against Greenwich 1s in the most exciting match of the month. Pre-season is typically a poor indicator of form and the season to come, and GKT are still striving to live up to the expectations of last season. The phrase ‘mixed bag’ is often overused and one would be loath to trundle out clichés but this time it is probably apt.

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November 2013  
November 2013