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medicalstudent The voice of London’s Medical Students

October 2011

London for medical students Centerfold 8-page pullout

Westminster blocked NHS protests on bridge Page 4

Crisis Hits Medical Schools Katie Allan

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

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

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

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

Health and safety - the danger of doctors Page 8

Trial by tube - TFL woes for medical students Page 12

Human Art - interior design on a body Page 14


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October 2011

News

medicalstudent

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

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

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

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

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

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

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

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Find us on Facebook and Twitter medicalstudent newspaper

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

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

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

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

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

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

medicalstudent

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

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Contact us by emailing editor@medical-student.co.uk or visit our website at www. medical-student.co.uk

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


medicalstudent

October 2011

3

News Gareth Chan RUMS Senior President

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

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

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

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

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

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

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

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Jeeves Wijesuriya UH President

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

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

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

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

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4

October 2011

News

Research in brief

Bridge over troubled NHS

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

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

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

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

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

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

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

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

medicalstudent

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

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

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

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

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


medicalstudent

October 2011

5

News

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

F

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

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

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

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

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

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Signing my life away. Image by Chetan Khatri

Calendar of Events

BL Medgroup  999

GKT Medgroup  999

ICSM Medgroup  999

17th October

17th October

19th October

22-23rd October

19th October

2nd November

31st October

21st October

William  Harvey  Day Student  Staff  Conference BL  Music  Freshers  Concert

3rd November

Auditions  for  BLSA  Show

7th Novermber

Medic’s  Tour

Halloween  Party

Christmas  Comedy  Revue

30th November - 2nd December

17th October

Graduation  Day OXJAM  Festival

RAG  Halloween  Collect

25th October

Freshers’  Plays

11th November

RUMS Medgroup  999

17th October

SGUL Medgroup  999

17th October


October 2011

6

Features

medicalstudent

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

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

Not the ideal leader.

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

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

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

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

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

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


medicalstudent

October 2011

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

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

7

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

“Given the importance placed on leadership and management skills, it is surprising how few medical students are aware of the concept at all” For   example,   students   at   UCL   are   as-­ signed  projects  to  follow  a  patient  with   a  chronic  illness  over  the  course  of  their   first  clinical  year.  One  such  student  no-­ ticed   that   there   were   certain   recurrent   problems   encountered   by   patients   on   their   journey.   A   project   is   now   under-­ way   to   improve   certain   aspects   of   the   patient   pathway.   Students   notice   these   things   every   day   and   should   be   brave   enough  to  be  an  advocate  for  patients.   Support   for   this   project   is   being   provided   by   a   society   recently   set   up   at   UCL.   Several   medical   schools   now   have   their   own   ‘Medical   Leadership   and   Management’,   or   similarly   named   society.   Young   Civitas   for   Medics   is   an  independent  group  supported  by  the   think-­tank  Civitas  that  provide  debates   and   talks   around   clinical   governance.  

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

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

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

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

movements  could  be  seen  in  slow  mo-­ tion.  From  this  pioneering  work  in  the   employment   of   comparative   anatomy   to   elucidate   human   anatomy,   Harvey   proceeded   to   deal   in   a   logical   manner   with   the   various   difficulties   in   fol-­ lowing   the   course   taken   by   the   blood. Harvey   also   measured   the   capacity   of  the  chambers  of  the  heart  and  calcu-­ lated   their   output,   this   being   the   first   instance  of  ‘quantification’  in  physiolo-­ gy.  Harvey’s  discovery  was  perhaps  all   the  more  remarkable  because  he  had  no   means  of  demonstrating  the  minute  de-­ tails.  This  skilled  and  ingenious  inves-­ tigation  led  Harvey  to  discover  the  se-­ quence  of  this  mechanism  of  the  heart.  

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

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

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October 2011

8

Features

medicalstudent

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

T

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

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

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

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

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

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

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

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

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


medicalstudent

October 2011

9

Features

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

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

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

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

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

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

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

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October 2011

10

Comment

medicalstudent

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

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

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

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

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

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

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medicalstudent

October 2011

11

Comment

Rubbing salt in the wound David Fisher Staff Writer

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

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

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

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

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

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

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

.

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


October 2011

12

Comment

medicalstudent

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

B

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

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

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

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

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

.

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

BUCS thought it was all over...

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

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

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

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

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

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

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


medicalstudent

October 2011

13

Comment

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

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

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

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

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

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

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

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

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

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

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

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

The Liberal Lunch By Rob Cleaver

include crisps in my lunch.

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

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

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

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

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

Just to spice things up a bit. I also

It was during one of these bonkers

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

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


TOTO Eclipse of the Arse

Sudoku

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

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

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

Look for the answers in the next issue!

Just a thought.

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

A N S W E R S

A N S W E R S May 2011 Answers!


Required: Editor-in-Chief 2012

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


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

medicalstudent

LONDON FOR MEDICAL STUDENTS

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


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Barts and The London Bars

Restaurants and Cafes

Vibe  Bar

Tayyabs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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October 2011

3

St George’s Bars and Clubs

Restaurants

The  Trafalgar  Arms  

Lahore  Karahi  

Traditional  pub-­grub  and  decently  priced  drinks.

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

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

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

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

The  Antelope  

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

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

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

Masaledar  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

teaching and student activities

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

are situated here, along with the

Cineworld  cinema

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

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

it is also the only med school

which is situated in Tooting. All

Afters  dessert  bar  

Odeon  cinema

medical school left in London,

Peperoncino  Pizzeria  

Cinemas Southside Wandsworth, London SW18 4TE

Not only the only independant

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

all important student union.

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

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


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October 2011

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

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

medicalstudent

London Lis


medicalstudent

October 2011

stings Map

5

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


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GKT Eating and Drinking

Del  Aziz  

Frank’s  Café  and  Campari  Bar

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

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

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

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

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

Scootercaffe

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

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

132 Lower Marsh, London SE1 7AE

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

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

Roebuck

takes place at the Guy’s campus,

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

along with the Guy’s bar which is

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

at the centre of the GKT medical student union.

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

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

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

Chumleigh gardens Camberwell, SE15

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

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

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

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

Student Beans

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

This is the most up to date website for

21-22 Maiden Ln, London WC2E 7NA

discount offers. Before you do anything, check

Ain’t  nothing  but

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

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

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


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ICSM Restaurants

Museums & Attractions

Blue  Elephant  (Thai)

The  Natural  History  Museum

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

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

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

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

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

Hummingbird  Café  

Hyde  Park

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

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

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

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

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

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

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

Royal  Albert  Hall

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

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

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

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

The  Distillers

campus (along with all other

Beirut  Express  (Lebanese)

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

degrees) but clinical work is

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

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

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

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

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

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

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

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

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

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

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

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

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

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

mainly at Charing Cross Hospital in Hammersmith.

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

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


medicalstudent

October 2011

8

RUMS Restaurants

Museums

Iccos

Hunterarian  Museum

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

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

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

35-43 Lincolns Inn Fields, London WC2A 3PE

Guanabana  

The  National  Portrait  Gallery

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

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

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

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

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

96 Euston Road, City of London NW1 2DB

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

Markets & Attractions

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

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

33-34 Rathbone Place, London, W1T 1JN

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

The  Roxy  

 Camden  Market

 

             OR

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

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

3-5 Rathbone Place, London W1T 1HJ

Chalk Farm Road, London NW1 8AH

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

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

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

London For Medical Students by: Robyn Jacobs Kiranjeet Gill

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

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

Photographer: Yuanchao xue

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


MS_October_2011