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mediscope Jan 2009

When Disaster Strikes Medicine in the Military Life Support Poster Competitions Reviews

Conflict & Disaster Manchester Medical School’s Student Magazine


What’s inside

mediscope EDITORIAL TEAM

Q+A

How would you describe this issue of Mediscope in three words?

andrew cheng

Year: 4, MRI Q+a: A fresh evolution

James goodman

Year: 4, MRI Q+a: Interesting, informative, imaginative

ahmed hankir

Year: 4, Wythenshawe Q+a: Exceeding everyones’ expectations

10 14

Lucy hollingworth

WHEN DISASTER STRIKES

STUDENT SUPPORT

?

?

?

21

AGONY AUNT

31

CONSTANT GARDENER

Year: 4, Wythenshawe Q+a: International, topical, insightful

Khimara naidoo

Year: Intercalating - Pathology Q+a: Look no further

Prizzi Zarsadias

Year: 4, MRI Q+a: Something for everyone

PHOTOGRAPHERS & ILLUSTRATORS „ Martin Fergie - PhD Computer Science, year 1 „ Daria Savilova - Management, year 1 „ Scott Davidson - Art, year 2, University of Derby „ raul orozco - Columbia

Issue 4 Chief Editor: Prizzi Zarsadias Web: www.mediscopeonline.com Editors: editor@mediscopeonline.com Article Submissions: articles@mediscopeonline.com Subscription Enquiries: subscriptions@mediscopeonline.com Competition Entries: competitions@mediscopeonline.com Production & Layout: Andrew Cheng „ Front, Editorial, Info, Education, Careers, YourScope, Society, Reviews Prizzi Zarsadias „ Features, Education, Poster, Back


01.09

EDITORS’ LETTER

G

reetings from the new editorial team - we welcome you to a new year and a new look magazine! Last year’s editors revived Mediscope with three exceptional issues. Their great work has set some high standards which we hope to have emulated with this issue. ‘Conflict and Disaster’ is the theme for this issue and we aim to raise awareness of some of the misfortune that has befallen millions of people with our lead feature ‘When Disaster Strikes’. It is also a testament to the enthusiasm of medical students who contribute to these worthy causes. Conflict is suffered on many levels, not just on an international scale. It can be an internal struggle, one we face in certain dilemmas - ‘Is there a student doctor in the house?’. The poem ‘Song for Sophie’ also reminds us that disasters aren’t confined to the global scale; they happen closer to home as well. It’s not all doom and gloom- if you’re after some light entertainment then check out our reviews section or enter one of our competitions. We hope you enjoy this issue as much as we have enjoyed putting it together. We would like to thank all our sponsors, including the medical school, for supporting us in producing this issue.

Mediscope Editorial Team 08-09

INFO FEATURES EDUCATION

CONTENTS CAREERS

SOCIETIES

YOURSCOPE REVIEWS

4 Paul O’Neill Medical school and national news

14 Student Support Dr John Shaffer explains all

26 A Bitter Pill to Swallow The ‘top-up fee’ drugs debacle

5 Rickets on the Rise A disease not left in the past

15 Student Doctor in the House? Would you respond?

27 Lebanon Running a hospital in Lebanon

6 Global Health Conference Coming to Manchester March 09

16 Poster BLS & ATLS

27 YourScope Mediscope hits Oxford Road

6 Also in the News Health news from around the world 7 Horizon Centre Closure Asylum seekers left in the dark 8 Clampdown on Sex Work New laws tackle sex trafficking 9 Competition Causes of clubbing wordsearch 10 When Disaster Strikes How the world responds 12 Song for Sophie A poem by Rev. David Grey 13 Marathon des Sables Beyond The Call of Medicine

18 Peer Assisted Learning Scheme Helping your ‘pals’ 18 Competition Mnemonics 19 Obs & Gynae Not for the faint hearted 20 Breaking Bad News Bryony Clarke shares some tips 21 Agony Aunts Cyneek Vs Candy 22 Highway to Helmand Medicine in the military 23 Sports Medicine A growing new speciality 24 European Working Time Directive How it will affect us

28 Medsin Choose your project 28 MMSC Medics making fundraising... Fun! 29 Medical Debating Society Smart way to argue 29 Chernobyl Children’s Project Disaster restbite 30 Pastest DIY Examination Useful or useless? 30 Bad Science Book by doctor turned author - Ben Goldacre. Win yourself a copy! 31 Constant Gardener Yuran Zheng on this moving epic


4 6 7 8

Paul O’Neill - Medical School News

infoscope Asylum Seekers’ Centre Faces Closure Global Health Conference 2009 Clampdown on Sex Slavery

infoscope

Professor Paul O’Neill, Head of Manchester Medical School, returns for another Mediscope newsbite

I

am pleased to be able to write another article for Mediscope, although the new editorial team assures me that it is nothing to do with me agreeing to part-fund the magazine’s production. In reality, I think that the School should support Mediscope as it is another way that the students and staff can communicate with our large student body. I would also urge you to have a look at the MEDLEA blog that Professor Caroline Boggis has set up in her role as the Director of the MB ChB course. Many of our staff will be contributing to this over the coming months. Local In Manchester, we were disappointed with the results from the National Student Survey, particularly in ‘assessment and feedback’ and also ‘organisation and management’. We think that part of the reason for these results is the complexity and size of our programme over a wide geographical area. Nevertheless, we take such feedback very seriously and we already have in place major changes to Year 5 of the programme, which include moving the main assessments to January. This will allow us to focus in the second half of the year on making sure that all our graduates will be prepared for practice. We will be giving standardised feedback to each student following these assessments and offering an individual session with a clinical mentor. Other changes, in 4 mediscope 01/09

A familiar sight, Stopford Building Martin Fergie

Year 5, include whole year seminars on preparing for the exams and introduction of workplace assessment. Detailed feedback from assessments is something that Dr Chris Harrison is planning to roll out across the programme in his role as the incoming chair of the assessments committee. We are also planning a review of the Year 4 programme given that the NHS is implementing different patterns of care in specialities such as children, women and mental health as well as elderly care. It is important that our programme reflects these so that, again, we can ensure that you will be well prepared for practice.

I was very interested in the last edition of Mediscope on global health, as this is something where there is a lot of national and local interest. Professor Tony Redmond, Dr Katie Reed, Mr Ged Byrne and Professor Val Wass are taking a lead in this and we have introduced a module in global health within the intercalated Masters degree in Public Health. We hope to extend these initiatives into the main programme and are considering SSCs linked with specific international partners. As I write, the School of Medicine is waiting for the results of the Research Assessment Exercise, which


infoscope means a great deal to the University, both in prestige and in funding. In Manchester Medical School, we have a special interest because our education research was ‘returned’ for the first time within the School of Education submission. This is a great marker of

at the Trust. The other excellent piece of news is that Professor Karen Mann from Dalhousie, Canada has joined us in a part-time appointment. Karen is one of the international leaders in medical education and she is working with us on several projects.

“ We are considering SScs linked with specific international partners ”

naTionaL The General Medical Council is about to issue a new edition of Tomorrows Doctors for consultation and its implementation will have an impact on those of you in the early years of the programme. It is likely to place a greater emphasis on gaining good clinical experience approaching graduation, with more clarity around elements such as shadowing Foundation doctors and induction into the Foundation programme. Another major emphasis may be on prescribing and therapeutics and these are areas that cause the greatest concern to Foundation doctors. New guidelines for medical schools are about to be issued and

rickets on the rise

khimara naidoo - intercalating (pathology)

our progress in making your education based on research evidence and I am grateful for Professor Tim Dornan for his strong leadership of the medical education research group. Finally, I would like to welcome Dr Kamran Khan (anaesthetics) and Dr Colin Lumsden (paediatrics), our new Senior Teaching Fellows at Lancashire Teaching Hospitals Foundation Trust. I am sure that they will add a great deal to the student experience

whY the increAse? „ Firstly, the pigment in darker skin reduces the effects of sunlight so that larger amounts are required to produce adequate vitamin D levels. In addition, the past two summers have seen belowaverage levels of sunlight in the UK. The combination of these factors thus places this population subset at greater risk of developing rickets.

R

ickets is a chronic condition caused by a lack of vitamin D, and is characterised by poor growth and developmental delay. It has been linked to an increased risk of cardiovascular disease, diabetes and osteoporosis. In addition, the disease puts both the family and growing child under significant psychological and social stress. There has been a recent surge in the incidence of Rickets in the UK, especially in individuals from South-Asia (India, Bangladesh and

„ Secondly, the use of traditional clothing, such as the hijab, limits skin exposure to sunlight. Dietary sources of vitamin D therefore become increasingly important when there is inadequate exposure to sunlight. However, many South Asian individuals favour strict vegetarian diets which are low in vitamin D. Maternal vitamin D deficiency has also been implicated. Low vitamin D levels during pregnancy can lead to early onset rickets.

we will have to make sure that our approach in Manchester fits with these. The other major project is the consideration of the recommendations from the Tooke Report into Modernising Medical Careers (MMC) and the Medical Training Application Scheme (MTAS) debacle. A key recommendation was substantial changes to the structure of postgraduate training, but it is not clear yet how the Department of Health will proceed with this. A new advisory body (Medical Education England – MEE) is being set up and I will keep you informed of any concrete proposals. The selection for Foundation training will remain the same until 2011, although it may change after that (watch this space). I am keen to be helpful to you so if you have suggestions on what I might write about, either in future editions or on the MEDLEA blog, then contact me on: Paul.A.O’Neill@manchester.ac.uk

Pakistan). Central Manchester has a large ethnic minority population and a high number of new cases are being reported each year. Skin experts at The University of Manchester say the bone disorder is on the rise amongst South-Asian children due to a combination of different factors (see box). Although the number of cases of rickets is relatively small, each case is unnecessary as rickets is preventable by appropriate vitamin supplementation. There has been little research conducted on the sunlight requirements of South-Asian people. The University of Manchester Photobiology Unit has now launched a study to discover what levels of sunlight exposure are needed to provide sufficient vitamin D for people with South-Asian skin. 01/09 mediscope

5


infoscope Beth McElroy - GHC Chairperson Luke Baker - GHC Publicity

T

he Medsin Global Health Conference is coming to Manchester in March 2009! It is your chance to get involved in the biggest forum of its kind within the UK. Entitled ‘Healthy Interventions’, the conference will tackle topical issues affecting millions of people around the world (see ‘Topics’ box). Over 500 students from across the UK will converge on Manchester for this exciting weekend event. This is your opportunity to hear expert speakers from across the UK, attend a selection of different workshops of your choice, have your say in our

debates and    connect with health campaigns and organisations. If you have an interest in other cultures and countries, health inequalities and politics, then this conference is for you. It intends to help broaden your knowledge of a topic neglected in the core medical school curriculum and prepare you for future work in the international field. In addition to the main conference programme, there will be an ethical and environmental fair, photo competition and film screenings. Food

helping with the conference „„ If you want to be involved with the organising team email: recruitment@ghc.medsin.org „„ If you would like to run a workshop email: theme@ghc.medsin.org „„ To volunteer to host non-Manchester students for the weekend (28th-29th March) email: accommodation@ghc.medsin.org „„ To enter a photograph in the photo competition email: logistics@ghc.medsin.org

local

National

topics „„ The ethics of humanitarian aid „„ The big players in global health governance and the consequences of their policies „„ The specific needs of the asylum-seeking population „„ Obstacles to health provision in vulnerable groups and drink will be provided within the ticket price (student discount available), as well as a conference goody bag. Finally, no conference in Manchester would be complete without a party, promising live entertainment and music in The Academy. We can promise a great weekend for those that attend. Please keep an eye on our website www.ghc09.org for tickets or join our Facebook group (Global Health Conference Manchester 2009) for more information.

interNational

„„ From June 2009, the £500 million building project around the newly named, Central Manchester University Hospitals NHS Foundation Trust, will begin to open. It will contain, amongst other departments, a new children’s hospital; the largest single-site children’s hospital in the UK. The hospital has also been granted foundation status.

ALSO IN THE NEWS

  James   Goodman

Manchester

„„ Conjoined twin, Faith Williams, died on Christmas Day 2008 at Great Ormond Street Hospital in London. The four-week-old girl and her sister Hope, were born on November 26th to Laura Williams, 18 - Britain’s youngest mother to give birth to conjoined twins.

„„ The smallest baby ever born in Greater Manchester at Salford Royal Hospital, has just celebrated her first birthday. She was born almost four months premature weighing just 1lb 2oz.

„„ A BMJ systematic review of randomised controlled trials of traditional and complementary medicines found no effective intervention for either preventing or treating hangovers. “The idea you can cure a hangover is a medical myth”, reported The Times.

„„ A baby in Florida, Rowan Santos, who was diagnosed with Retinoblastoma remains free of cancer months later. Madeline Robb, from Stretford, Manchester diagnosed the cancer from photos sent by e-mail, after spotting an earlywarning sign in her eye.

„„ No charges are to be brought against the parents of 23 year old Daniel James, who died at Dignitas in September 2008. He was paralysed in a rugby accident and ended his life despite not being terminally ill. PM Gordon Brown has said he is “totally against” changing laws on euthanasia.

6 mediscope 01/09

„„ The world’s first successful trachea transplant was performed on 30 year old Columbian, Claudia Castillo, in Barcelona in June 2008. It was the first tissue transplant to use the recipient’s stem cells and thus negate life-long immunosuppressive therapy to prevent rejection. „„ Between August and December 2008, there were over 29,000 reported cholera cases in Zimbabwe with over 1,500 deaths. The UN has said it may take until June 2009 to control the outbreak. „„ A team of London doctors have climbed Everest to study the body’s response to extreme conditions, in attempt to improve treatment of patients with critical lung conditions. In their work (published in the NEJM) they recorded the lowest ever level of arterial oxygen in humans (2.55KPa).


infoscope

Salford’s Beacon for Asylum Seekers Faces Closure Beth McElroy

W

hen asylum seekers arrive in the UK they are

for access to valuable social support. In mainstream practice

plunged into a world of disorientation and

different expectations of healthcare and language barriers may

confusion. Culturally isolated, they enter a climate

compound difficulties asylum seekers face navigating the NHS.

of suspicion and a labyrinth of bureaucracy. Their asylum

Approximately 75% of patients need an interpreter and asking

application marks the beginning of a long and difficult struggle;

friends or family to act as translators, contravenes the European

one that may compromise their dignity, liberty and their health.

Human Rights Act. Whilst the long term aim of integrating asylum services and

When the NHS was founded, it committed to care for all

increasing awareness across the PCT is a good one, the pros-

those in need. This core principal appears to be under threat.

pect is currently impractical. Although the HC has difficulties

Nationally, the government is advocating the withdrawal of pri-

accessing outlying patients, it offers an essential specialised and

mary care from failed asylum seekers. Locally, Salford Primary

holistic service. In my opinion, the PCT should develop this

Care Trust (PCT) is proposing ‘mainstream integration,’ which

Gold-Standard service and facilitate changes within the existing

will see health provision for asylum seekers diluted.

framework.

Asylum seekers are a vulnerable group with different

The Horizon Centre acts as a beacon to asylum seekers who

healthcare needs. They include unaccompanied children,

would, without this resource, struggle to keep their heads above

women that have suffered genital mutilation and individuals

water. To comment on the proposed changes please visit:

who may have been tortured, raped or imprisoned during

http://www.salford.nhs.uk/asylum/pcfbody.asp?id=8

conflict or as persecution for their political or religious beliefs. In addition, low income levels, poor shared accommodation, lack of family support and distressing visits to reporting centres with the fear of impromptu detention, broaden barriers to mental and physical well-being. There is a high prevalence of patients suffering from depression, anxiety and post traumatic stress disorder (PTSD). Salford PCT set up the Horizon Centre (HC) in 2004 as “the answer to many problems identified around asylum seekers attempting to access primary care services.” This specialist team provides primary and social care services to patients in a culturally sensitive environment during the complex asylum process. The proposed model for Salford advocates a new service whereby asylum seekers register with a mainstream GP. The selected, additionally trained practioners will be able to refer particularly vulnerable patients to a specialist team “for more intense support and treatment in times of crisis or specific need.” This logistical nightmare would mean many patients may, once again, have their healthcare needs marginalized. Around 15% of the clients currently registered with the HC suffer from PTSD, some of whom require weekly support. Consistency is important to encourage disclosure without triggering distressing flashbacks. Such needs cannot be addressed in general practice. Overstretched GPs may struggle to produce medico-legal reports for court at short notice and patients may be left fighting

01/09 mediscope

7


infoscope

Ami Pederson, intercalating medical student and Manchester Action on Street Health (MASH) volunteer, outlines plans the Home Secretary, Jacqui Smith, has introduced to tackle the problems faced by sex workers and asks how the law will change and what the health implications of this are.

clamPdoWn on seX

C

laimed to be the oldest profession in existence, prostitution has long been an associate of crime, ill health and social stigmatism. Those working on the streets often have more chaotic lifestyles and the allied negative health consequences of drug and alcohol abuse, when compared with those based in parlours. Despite this, the health status of sex workers has been steadily improving, primarily due to an increase in safer sex and the increasing availability of support. However, there has been a sharp rise in immigrant sex workers, tied to increased reports of trafficking, who face the additional health issues related to the cramped living conditions, long working hours and little food. The law, as it stands, is complex. The Sexual Offences Act 1956 illegalises the running of brothels, soliciting on the street and kerb crawling, though only if this is a recurrent offence. In addition, the Sexual Offences Act 2003 outlaws

8 mediscope 01/09

slaVery

those people who cause or control prostitution. Prostitution itself, therefore, is not illegal but many aspects surrounding it are. The proposed changes amend the current situation in a number of ways. Kerb crawlers do not have to be proved a persistent nuisance to be prosecuted. Brothels will no longer have to be associated with anti-social behaviour or Class A drugs to be shut down. Finally, and this is where Smith has interested the press, it will become illegal to pay for sex with someone who is controlled for another person’s gain. Such an offence will also be ‘strict liability’ –

“it will become illegal to pay for sex with someone who is controlled for another person’s gain” not knowing that a sex worker was controlled by another person is not a legitimate defence. The new proposals aim to make

it easier to protect trafficked women. Under the new law, traffickers are committing a clear cut offence, and anyone buying sex from a trafficked sex worker can be charged with rape. Smith believes such steps are long overdue and are likely to lead to more successful prosecutions and “send out a message to men to think twice”. Critics however, have found fault with the new proposals on many levels. The Scottish Prostitutes Education Project believes that many sex workers choose their occupation and find the new measures are belittling. More worryingly, the sex industry may simply be driven further underground to evade the authorities. This could make life more dangerous for the sex workers as well as making it more difficult for services such as MASH to maintain their point of contact care - important when working with unpredictable clients. This could arguably see the previous rise in the health status of sex workers, begin to fall again.


For your chance to win a copy of Puzzles for Medical Students, find as many causes of clubbing as possible. The person who finds the most causes, wins! If there is a draw, we will pick a winner at random. There is also a 20% discount code for all Scion Publishing books for everyone who enters. Simply send your completed puzzle to ‘Mediscope Competitions, 28 Beech Grove, Manchester, M14 6UY’. Alternatively, take a high resolution photo of your wordsearch and email it to competitions@ mediscopeonline.com. All entries must be submitted by 1st April. Winner and answers will be published in the next issue of Mediscope. Good luck! important terms & conditions: • Previous winners of “Puzzles for Medical Students” are not entitled to enter. • Only one entry per person. • See http://www.mediscopeonline.com/comp.pdf for our general terms and conditions

mediscope

causes of cluBBinG

comPetition!

details

M C QX K V G K T T T F R J T F K C K K N L WC L B XR C H T RHCY HNNCOE L I AC D I S E A S E CN F XR L OP K Y R B T K N J T MN A N R Y S B D L RM G C J R V N L N T M P R G L B X K J WWM P G S I Y M C L T R F A H M D R G C R T F K W X V B M J P O V M T S M C T Z B B S T N T WD E B J OWK Z L Y Q H H MN N L I O G D Q Z K B X WH Y K P N D K G X X X P R N Y G Y I L Y C H T D J N E WM Y M R P W I N B E X N H D L P Y G Y C L K F RMMWS NM R Z C Z B X T W C N F T D T Y XC C Z R B K I RM L T QK ON Q T D K T A Y B I H R W L C R Y X B A F R B I D O WM T M F M H H T N L T L C H GH Y G F Z N T C Z BR C S R X OQH NM T YR MC H L F C T D K H C J GD L J BO I T L XWQT R V K R G V YR D I J R A G R WV K H A T N S K X I T V Q X S L R F T Y A N D B WB O P T K M T M I R Q I N C Z J Q K I Z B K G R H N C WR R G R H O H K T VH J F S ON L M J T Z T F K T K VO K R OT H K ON I C Z ZC L T S P Q L N I GN J RQRR Z T V R S L R X W N S D X WN P I G L K T L L G D R N L R Y N I D V I L Z R H L C D I MO S P G WX O V X WY R R F D P D C Q K NM K M C K J H I J R Q A K J C P XWN R C T T R H KH C M GQH H N Z R F I S B MQ F E L U N G A B S C E S S N E T Q A Y M K F WF L R E E MM V H C L N Q QT H Z D R R N A T W L M L Q Z MQ Y K Y C A I X D F WK L F NW L C M L T R M N V MM K M N Q T P C Z T S Y F F P Y F WX N J C P N P T L N E R G K X P B M H G A V A E F F K L Q L V GM Q Y B K D P C O Y B T M L E K H R D Y G S V M GWX N L V M P Q Y B I Y R L K T V Y T V J E T Y R C D I K C B M R R Y M T T MC S X K I MM J M X D C C H M B G P WS R T Y L RWK P X K K E Z G T L L X V G L V T N L Q G Z WP L N V WK H R Z R K L A B T I Y X WJ U Z Q V Y X F N R PMWL WT D T H T N BC SN K S S I T I D R ACOD N E L A I RE T CA B G V VNN E J

(PRInT CaPs)

fullNamE: yEar: mobIlE: EmaIl:

mediscope

Find 15 causes of clubbing in the grid above. Words can go horizontally, vertically and diagonally in all eight directions.

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10 12 13

When Disaster Strikes Song for Sophie - Poem Beyond the call of Medicine

featurescope

WHEN DISASTER STRIKES Worldwide billions of people’s lives are devastated by both man-made and natural disasters. However, the true gravity of what it means to be amongst them is rarely registered in the consciousness of those whose lives have not been touched by it. Media attention is often pre-occupied with domestic news. A collaborative essay by institutes in the UK, USA, Denmark and Finland has shown that in the UK and US especially, poor coverage of international news has had an impact on public awareness. Without awareness, how do we hope to help? As recent statistics have shown that natural disasters are on the increase, public awareness has never been more important. This year alone, Cyclone Nargis in Manyamar claimed the lives of 138,366 lives, the most fatalities of any natural disaster in 2008. Conflict has also led to the inevitable loss of life- in the five years of fighting in Darfur, an estimated 5.4 million people have died. Members of three Medical School societies tell us more about the causes they strive to help

Chernobyl by winds and brought to C h i l d r e n ’s P r o j e c t the Carried ground by rainfall, the radioactive Tal�ing about the Chernobyl nuclear disaster can be �uite frustrating for Jessi�a Co��ins and Jona�hon He��ro�, third year medical students and members of the Chernobyl Children’s Pro�ect

P

eople tend to know very little about the incident branded ‘the worst man-made disaster ever

to have occurred,’. So firstly, a little history… During a test on 26th April 1986, Reactor number four at the Chernobyl Nuclear Power Station overheated and exploded. The force of the explosion blew off the 1000-tonne sealing cap, releasing what is thought to have been 200 times more radiation than the Hiroshima and Nagasaki bombs combined. It is the only disaster ever to be rated 7 on the nuclear events scale, making it the worst in history.

materials contaminated many parts of the world, including the UK. The

raised levels of background radiation, but also because of the irradiation of gametes in the first generation after the disaster. Socially, the people of Belarus are

worst affected country was Belarus,

still struggling to cope. In the first few

situated just north of Ukraine. 70% of the

years following the disaster, people were

radiation fell here, contaminating 23%

anxious about the effects of the radiation.

of its territory with Caesium-137 and

This worry was exacerbated by the lack of

Strontium-90.

information given to them, especially by

So, what were the main consequences

the government who did not explain the

of the disaster and are they still present

extent of the contamination. Understand-

today?

ably, people also found it hard having to

Health problems caused by the disaster have created the most attention,

leave their homes and villages. Later, when the true consequences

including a 30-fold increase in thyroid

became apparent, various social implica-

cancer, particularly in children. The

tions followed. Disturbingly, disability in

World Health Organisation predicts that a

Belarus is viewed in a similar way to how

third of all children from the Gomel area

it was in the UK years ago. There is con-

of Belarus aged between 0 and 4 years

siderable stigma associated with disabil-

at the time of the disaster will develop

ity and those suffering are often neglect-

thyroid cancer during their lifetime; a

ed. This results in many children being

total of 50,000 in this group alone. This

abandoned or given away to orphanages,

“The Who predicts that a third of all children in the gomel area... will develop thyroid cancer”

is attributed to the large uptake

in which they receive no education. Only

of radioactive iodine-131 by the

recently has the “Right to Education for

thyroid gland after intake of

All” legislation been passed in Belarus,

contaminated food products.

challenging the preconception that if

Increases in other cancers have

children were disabled, they could not

also been recognised, with a

participate in activities.

50% rise recorded in cases of leukaemia, in both children and adults in the Gomel region since the disaster. There has also been a rise in

So what is being done to help the people of Belarus? There are several different Chernobyl committees in place to deal with the

reproductive problems including

consequences of the Chernobyl nuclear

miscarriages, premature births and

disaster on a national scale. However

a three-fold increase in congenital

these organisations do not tend to help

abnormalities and developmental

the people on a personal level, this is

disorders. This is not only due to the

mainly done by charities.

Illustration by Scott Davidson


Red Cross

Ni�ho�as Le�is, fourth year medical student and president of Manchester University’s British Red Cross, emphasises our apparent ignorance of international atrocities and the role played by The International Red Cross and Red Crescent Movement.

Médecins Sans Frontières ra�he� pearson, intercalating medical student and vice president of Friends of M�decins Sans Fronti�res brings attention to how MSF are wor�ing to help individuals who are more than �ust statistics

T

world’s largest independent humanitar-

N

over 60 countries worldwide, treating

MSF has treated over 40,000 patients

ian organisation. One important part of

thousands of desperate people in areas of

with HIV. One of its main initiatives has

their work is to raise awareness about

disaster, conflict and displacement. Estab-

been preventing the transmission of HIV

crises.

lished in 1971, MSF operates outside of

to children. This has been fulfilled by pro-

he British Red Cross is part of the International Red Cross and Red Crescent Movement (IRCM), the

obel prize-winning humani-

of whom are children) with HIV in 32

tarian aid organisation MSF,

countries. In Zimbabwe, where two mil-

provides medical support in

lion of the population are HIV-positive,

political and religious bias, bearing wit-

viding Carbergoline to mothers, in order

survey has shown that most people in

ness (or ‘témoignage’) to the suffering of

to cease their production of breastmilk.

the UK are unaware of major conflict

their patients. They pride themselves on

This allows infants to be fed with formula

zones around the world. Respondents

being the first organisation to appear on

milk, which acts to prevent HIV transmis-

were able to name Afghanistan and Iraq

the scene when disaster strikes, and the

sion via breast milk.

as war zones. However, more than 60%

last one to leave when things get difficult.

Seven months ago Cyclone Nargis

mistakenly believed these countries had

‘Doctors Without Borders’ has hundreds

hit Myanmar in Burma and people living

experienced the highest civilian death

of projects across the world, providing

there are still suffering from the devasta-

toll of any conflict in the last ten years.

healthcare, drugs and medical equip-

tion left behind. Teams of MSF workers

Less than 1% identified the Democratic

ment to those in need. This article briefly

have helped them to rebuild their lives,

Republic of Congo, where an estimated

explores three ongoing projects; nutrition

focusing on basic needs such as safe

5.4 million people have died as a result of

in Ethiopia, HIV in Zimbabwe and assist-

drinking water and shelter. More than

the country’s long-running conflict.

ance after the Burmese cyclone.

A British Red Cross-commissioned

Disaster response continues to repre-

Worldwide, approximately five

“MSF cares for 100,000 people with hiV in 32 countries”

sent a large proportion of the work done

million children die every year from

by the IRCM, with assistance to around

malnutrition. With suppressed immune

30 million people annually. The social,

systems, they struggle to survive constant

35,000 medical consultations have taken

economic and political consequences of

attack from opportunistic infections. So

place, mostly focusing on the worst af-

disasters are frequently complex, and

far, MSF has treated more than 11,000 se-

fected Delta region. In addition to medi-

may involve the disruption of a com-

verely malnourished children in Oromiya

cal aid, MSF have provided counselling

munities’ self-help network, health

and the SNNP (Southern Nations, Na-

for those traumatised by the disaster.

infrastructure, and availability of food

tionalities and People’s) region in south-

and water. The IRCM therefore focuses

ern Ethiopia. These children are given a

to work for MSF and cannot go on

on community-based disaster prepared-

high calorie peanut-based paste (’Plumpy

elective with them. However, if you are

ness, thus reducing their vulnerability to

nutTR’) and therapeutic milk. As a result,

interested in making a difference as a

disasters and strengthening their capacity

the risk of these children developing

medical student, the recently established

to resist them.

debilitating oedema and kwashiorkor has

‘Manchester Friends of MSF’ society needs

What can you do to help?

been greatly reduced.

your help.

The British Red Cross First Aid Society

With the rising number of people

Medical students are not qualified

Manchester FoMSF aims to raise

runs first aid courses, which allow you

suffering from diseases such as AIDS,

awareness and fundraise for the organisation.

to provide first aid support at various

malaria and tuberculosis, there is a huge

To find out more email friendsofmsf@

events in addition to teaching first aid

need for support from aid organisations.

manchester.ac.uk or Facebook; Manchester

in schools. Passing on these skills is an

MSF cares for 100,000 people (7,000

Friends of MSF.

invaluable way of ensuring that, should a disaster happen close to home, people are prepared to assist in minimising its impact. Please contact firstaidsoc@hotmail.co.uk for further information.


Father/Mother god, you know its true: That things go wrong when we turn from you. I’ve known this child since she was six, but you’ve known her since the very first bricks of the universe were called in place, you know her name and you know her face; You know each call in her heart and soul and you know she’s strong- more precious than gold. No child of yours deserves this fate, bring us all to our senses before it is too late. forgive we elders who have let the young bloods down by failing to show them the common ground where life is precious and all are of worth who breathe your air and walk your earth.

For

S���

In June 2008, Sophie Funicane was shot in the head at close range following the accidental discharge of a weapon in her home by a family friend. Sophie courageously fought back against impossible odds and survived. Wayne David Bryan, 20, pleaded guilty to shooting Sophie in the head. Following the incident, Sophie was immediately taken to hospital for life-saving brain surgery. She regained consciousness after ten days and was discharged four months later. Sophie’s father described her as a `living miracle’. “a rap on heaven’s Door” was written during Sophie’s darkest and most bleak hours by Reverend David Grey. Look kindly on Sophie’s father John and ease the heart of her mother, Sharon; comfort her friends and family; Bless Cedar Mount school with harmony. You are working through those who have her care in a city where folk are so aware that our Children need a guiding hand to end the violence and truly honour the gangs.

S�����

Mothers Against Violence Fathers Against Strife Children for Freedom, for Justice and Life. Yet, you can Heal this girl in every way, with such a powerful message so that all may say: “We’ve trod the wrong path long enough, let’s get back on the Way of Love”. Be with her, Lord. Thy will be done for Sophie and for everyone who sends out love and healing prayer revealing that your world still cares. Thank you for what you can achieve through a single life that is bold and free; Thank you for the life she’s known but thank you more for what is yet to come. Photograph by Martin Fergie


Beyond the Call of medicine:

The Marathon Des Sables

feature scope

We will regularly feature the extraordinary ventures of those medics who take part in unbelievable physical or mental challenges, achieve exceptional academic recognition or those who make a real difference to the world that we live in. Think you have what it takes to be featured on this page? Then send in your article to articles@mediscopeonline.com

F

ancy a week in the sun with a difference? Enjoy hot temperatures and active holidays? Do you have

masochistic tendencies? Then the Marathon des Sables is for you. This ultra marathon is regarded as the toughest foot race in the world. It consists of running 155 miles over 6 days across the Sahara desert in temperatures of up to 55°C; it is

not for the faint hearted – literally. As if the distance and temperature were not challenging enough, each participant must be totally self-sufficient during the marathon. They must carry all the clothing, food and other supplies they deem necessary to survive the week. Marathon organizers provide the runners with nine litres of water for each day, and at night, participants sleep on the ground in communal Berber tents. The route of the event remains a secret

Andrew McMaster, second year medical student shares his preparations for a gruelling desert marathon check in at numerous “control points” along the way. My preparations to take part in this event started in June this year. Initial administration included obtaining a medical certificate from my GP and providing results from an ECG test. On filling out the entry form, I was slightly alarmed to read a section concerning the “corpse repatriation fee”. Undertaking research, it was also concerning to read about previous participants’ experience - Mauro Prosperi, a police officer from Rome got lost in a sandstorm during the 1994 race. He wandered several hundred kilometres off course and survived for the next nine days on boiled urine and dead bats. Mauro lost over 30 pounds during his ordeal but he has since returned to Morocco to race two more times. The fact that only two people have died while

“The fact that only two people have died while participating in the Marathon inspires some confidence in me!”

until the day before the marathon begins (as if you would be tempted to try it out beforehand anyway!). Typically, it takes place in the stunningly-beautiful desert to the east or south of the town of Ouarzazate. This arid terrain offers a blister-inducing variety of landscapes, including rocky hills, dried mud flats and sand dunes. The marathon is run in five stages ranging from 18 to 52 miles per day, with extensive route maps given to participants at the start of the week. The cruellest stage is day four, a double marathon segment which begins long before sunrise and often continues well into the night. A significant number of runners drop out over the course of this day due to its extreme physical and mental demands. The racing is tightly monitored, with all participants required to

participating in the Marathon inspires some confidence in me! However, it is slightly comforting to know that I am not the only person who is crazy enough to sign up for this torture test. Last year, 683 men and women from roughly thirty countries stepped up to the challenge. A team of 40 doctors are also present. Although I have undertaken a number of marathons over the past four years, this challenge certainly requires organised training. I am currently running around 50 miles per week in addition to participating in a number of UK-based road races over 40 miles long. By January, I will have to be fit enough to run 80 miles per week shortly followed in the year by double marathons to make sure that I am match fit. Luckily, I have not as yet suffered any injuries but I am careful to attend regular physio sessions with a great team at Disley Fountain

The cauSe i aM SuPPorTing St Ann’s Hospice is one of the largest adult hospices, in the UK, with 60 in-patient beds. Although cancer-related conditions account for 95% of all hospice admissions, St Ann’s services are available to patients with any life-threatening illness and 42% of patients admitted to St Ann’s Hospice return home after treatment. St Ann’s Hospice needs to raise £16,000 every day through voluntary contributions to offer its wide range of services. in total, it costs £8.75 million each year to run the Hospice, of which only 35% is received from government funding. it is the support of the local community that enables St Ann’s Hospice to continue providing the highest standards of care to patients, families and carers.

Square Clinic. I am undertaking this challenge to raise money for a local independent charity, St Ann’s Hospice (see box). Before my departure to the Moroccan Sahara, on the 27th March 2009, I am hoping to reach my fundraising target of £4000 through various activities. The charity is giving me a real incentive to focus as I carry on through the pain of the cold winter months… running fifteen miles in the cold and dark before a 9am PBL session is not a hobby! please visit my online fundraising website at www.justgiving.com/ desertmarathon2009 or email me at andrew.mcmaster@manchester. ac.uk if you would like to support me in any way with raising money for St Ann’s Hospice through this event.

01/09 mediscope

13


15

Is There a Student Doctor in the House?

19 20

Making The Most Out of O&G Breaking Bad News

educationscope

educationscope 18 Peer Assisted Learning Scheme

Student Support „ „ „ „ „ „ „ „

Academic Pastoral Personal Portfolio Projects Placements Career Health

in manchester medical school

W

e need to provide you with the best possible support; in return you need to inform

us as to your needs. Increased student involvement in the MSRC, student representatives and feedback will all help us to

by Dr Jon Shaffer

focus on specific needs and problems.

STuDenTS in neeD

Traditionally many students have been reluctant to come forward – as one US author quotes, “Medical students have typically been extremely successful throughout their prior academic and professional experiences, and it can be difficult for them to ask for help when they struggle. They may be reluctant to access these [counseling services] because of confidentiality concerns.” T. Shanafelt, Amednews.com, 20/Oct/ 2008. In the same article it was noted that up to 25% of US medical students in seven different schools had at one point in their undergraduate studies, considered suicide. Dr Shanafelt (from the Mayo clinic in Rochester) states that students start psychologically robust, but during the course of medical school “they experience a deterioration in their mental quality of life”. There is evidence that similar pressures occur in the UK and the rest of Europe. Medicine requires both an extensive academic as well as an intensive professional development programme. This combination, coupled with the raw emotions involved in patient care, can put significant strains on students’ feelings of well being.

Where To go In feedback surveys students have complained that they did not know where or whom to turn to for advice or help. A review of the handbook for each phase, the MancheSTer MeDicaL SchooL University tutors (PBL, portfolio, phase 1 and senior tutors) & hospital deans, or email medicalstudent. support@manchester.ac.uk UNIVERSITY OF MANCHESTER For information on student support and counselling services, visit: www.studentnet.manchester.ac.uk BMa counSeLLing Line 08459 200169 (24hours)

medical school website, as well as making contact with senior tutors, hospital deans and PBL tutors, can all point you in the right direction. Our office can also arrange appointments (see box).

TAKE ADVICE! Those offering help are usually experienced and are able to see the bigger picture, perhaps more clearly than the student involved. Students are given useful and practical advice, which can often lead to a positive outcome. Support, whether from family, friends, colleagues, or the medical school is all about helping you to achieve your true potential in the most enjoyable manner possible.

Dr Jon Shaffer is Academic Lead for Student Support and a Consultant Physician Daria Savilova

14 mediscope 01/09


Is there a student doctor in the house?

educationscope

Answering the call for help can happen anytime, anywhere. Anthony Howard, a 4th year medical student and Practising Barrister and Laura Neilson, an intercalating medical student ask, “what is the legal position of getting involved?”

Y

ou may have pondered how you would react to a tannoy on an aircraft asking for medical assistance or if you happened upon an injured individual. It is hoped that those who have a career in medicine would have an urge to help, but what are the legal pitfalls in adopting a Good Samaritan role? Recent research has revealed that 72% of doctors will face this situation at least once in their careers. We examine the legal position of getting involved and seek advice from organisations such as the GMC.

The Legal Position Defining negligence is difficult, but in simple terms, it is actions which fall below the “standard of a responsible body of medical men”, the Bolam test. In other words, you acted below the standard your medical colleagues would think was acceptable. The standard expected is specific to the individual; you are not for example, as a medical student, expected to have the resuscitation skills of an anaesthetist. You will be pleased to hear that in England and other jurisdictions such as Australia there has been no successful case brought by a victim against his rescuer. However, with the vulture type behaviour of some law firms, is it only a matter of time before this is attempted? For example, in 1988 there was an unsuccessful attempt to bring action against the St John Ambulance Brigade. The Courts in England have reasserted the position recently that should the Good Samaritan walk past then they will not attract liability for not becoming involved. If your involvement as a Good Samaritan does not worsen the situation for the victim then you are completely safe. The difficulty is if your involvement

worsens the situation and this was due to your negligence. Perhaps, the first question you will be asking as a medical student is what is the standard of competence against which I am to be judged? There has been no previously decided case as to the standard of care expected of you as a medical student. However, given the generally unattractive nature of the action against you, it is likely to be a standard commensurate to someone with first aid training rather than as a qualified doctor, although this perhaps depends on your stage of training. There is also potential for the victim to argue that your conduct is akin to assault or battery, both in the civil and criminal sense, but these are unlikely to succeed and the reasons are outside the scope of this article. The message is that you would have to be very incompetent to attract civil liability in England as a medical student acting as a Good Samaritan. Rupert Ellis of the MDU advises that “you should know your own limitations”, so best perhaps not to try internal heart massage when the only equipment available is a plastic fork!

The GMC Qualified doctors bound by the GMC’s Good Medical Practice have an ethical obligation, “In an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide.” This sets out in no uncertain terms the GMC’s view, which has been exercised when the GMC “admonished” a locum GP for refusing to attend to an elderly man who had collapsed in the street outside his surgery. As a medical student you are not strictly bound by this obligation, however, worth keeping in mind on your way home from your first day as an FY1.

Ethical Obligation All the six major world religions encourage followers to help those in need, for example in the Bible, Jesus admonishes those who ignore suffering. Away from religious views, even ethical frameworks that do not stem from altruistic thinking maintain that there is a responsibility to act. Non-malfeasance, doing no harm, has its roots in the Hippocratic Oath. There is an argument that not acting in situations like the one at the beginning of this article could in fact be interpreted as doing harm.

Insurance As a student you may not have insurance to protect you and even an NHS contract does not cover the situation. Certain airlines such as Air France and KLM have, in the past, treated a doctor who responds to a request for assistances as a temporary employee and thus covered by the airlines’ insurance policy. MDU members have worldwide insurance cover, on a discretionary basis, for claims arising from Good Samaritan acts; other defence organisations may also provide cover.

Conclusion You are perhaps not surprised to learn, particularly as the matter involves lawyers, that the position is complex and no real definite guidance can be given as the position of the Good Samaritan depends on the circumstances of the individual rescue. However, from a legal perspective the chances of you being successfully sued are very small and next to zero if you act within your capabilities. You probably have more to offer than you imagine and the fear of litigation should not stop you helping to save what could be someone’s life.

01/09 mediscope

15


Basic Life Support

Advanced

PRIM The initi

Here are some essential tips on the most important clinical skill that will ever come up in an OSCE... and your career! Content provided by Chee Pavey and Gill Ross. Poster design by Prizzi Zarsadias.

A

is for AIRW Assess th

As you approach the patient, assess the area for danger.

COLLAPSED PATIENT?

Is it clear? Open the a

Secure th

IF TRAINED TO: RESPONSIVE? (shake and shout)

YES

Assess ABCDE Give max O2 IV access Take bloods

ASAP: Call 2222 to fast bleep an

Maintain c ary injurie

appropriate doctor. (Put the patient into the recovery position. If you have to, leave the patient to do this)

NO SHOUT FOR HELP

OPEN AIRWAY & CHECK FOR SIGNS OF LIFE

CALL 2222 FOR THE RESUS TEAM

GIVE 30 CHEST COMPRESSIONS

Give compressions at a rate of 100/min to depth of 4-5cm. Some recommend singing Nelly the Elephant (in your head!) to maintain the right speed.

Head tilt/chin lift. Be cautious if cervical spine injury is suspected. Look, listen, feel for no longer than 10 seconds.

Make sure the breaths are slow. Maintain the airway and pinch nose during breaths. Simultaneously watch for the chest to rise. Only make a maximum of 2 attempts, then return to chest compressions. Q. When would you start with rescue breaths rather than compressions?

D

If in the community call 999, if in hospital use the internal phone system to dial 2222. Tell the operator “cardiac arrest” then location (eg ward2) and repeat.

OPEN AIRWAY AND ATTEMPT 2 BREATHS

CONTINUE UNTIL: 1. Patient shows signs of life 2. Expert help arrives and takes over 3. You become exhausted

Answers:

is for DISABILITY (neurological examin Conscious level – GCS or AVPU:

If altered check for any obvious cause. Glucose (hypoglycaemia), U &E’s, Tox. scree brain injury. (CT scan is indicated in most pa consciousness). Pupillary size and reaction. Rule out traumatic brain injury or spinal cor If a patient deteriorate at any point e.g. con then another primary survey is repeated.

SECONDARY This is a complete exami vital signs and a history

For the history, try to establish the nature of the injury. Follow the mnemonic ‘AMPLE’ to cover the necessary topics in these circumstances:

A M P L E

llergies edication (current) MH ast meal vent/enviroment leading to injury

Disclaimer: Questions included in poster are for learning purposes and are not guaranteed to be asked in OSCEs

Begin with rescue breaths in cases of drowning and paediatric resusication. The 8 reversible causes are Thromboembolic event, Tension pneumothorax, Toxicity, Tamponade (cardiac), Hypoxia, Hypovolaemia, Hypothermia, Hyper/hypo K, Ca, Acidaemia etc (metabolic disorders.) These can be remembered as the 4Hs and the 4Ts


d Trauma Life Support

MARY tial survey SURVEY is based around the mnemonic ‘ABCDE’.

WAY…maintenance and cervical spine protection he airway

? (Likely if patient is talking). airway – use head tilt/chin lift or jaw thrust.

he Airway

cervical spine in a neutral position to prevent secondes (use hard collar with sandbags on either side).

C

B

is for CIRCULATION with haemorrhage control Is the patient hypotensive? (record blood pressure)

ATLS is a standardised approach to the care and management of trauma patients in the initial stages. In particular, it is effective as a system planned to fully utilise the golden hour (the first sixty minutes occurring after a traumatic event following which, the survival rate falls significantly). ATLS consists of two assessments of the patient.

is for BREATHING and ventilation Chest Examination – establish if patient is breathing (record resp rate and SpO2) and whether there are life-threatening chest injuries. If so, treat! Hand-controlled or mechanical ventilation may be required. Supplementary high flow O2 is given as standard to seriously injured patients.

Are they in hypovolaemic shock? Is the patient’s cardiac output sufficient (possible cardiac tamponade)? Record pulse rate. Hypotension is due to BLOOD LOSS until proven otherwise! BUT, hypotension is a late sign of hypovolaemic shock in previously healthy individuals, therefore look for the other signs of shock

Signs of Shock

Don’t forget blood loss can be (a) External – apply direct pressure. (b) Internal - need imaging (e.g. focused abdominal ultrasound, FAST,) or explorative surgery e.g. laparotomy. If broken bones, traction helps reduce blood loss. Most internal bleeding requires emergency surgery. Treatment: establish IV access at two points with wide bore needles. Use saline or isotonic crystalloid e.g. lactated Ringer solution (fluid resuscitation)/ type specific or type O blood.

nation)

en – if all normal assume atients with decreased

E

rd damage nscious level changes,

is for EXPOSURE and ENVIRONMENT Fully expose patient and examine their entire body Log roll patient to look at back and front. Cover the patient with blankets to prevent hypothermia. Try to keep a warm environment - even I.V fluids should be warmed.

Cool clammy pale skin Weakness Confusion Oliguria or anuria Tachycardia- weak thready pulse Tachypnoea Drowsiness Confusion

Essential Investigations Bloods: FBC, U&E, ABG, Group and Cross match. ECG. Trauma series: Cervical spine X-ray, chest X-ray.

SURVEY

ination of the patient from head to toe encompassing all systems. There is reassessment of all Q. What are the 8 reversible causes you should consider? is taken. The second survey is often not carried out as thoroughly as the first and can occur a considerable time later due to investigations or surgery taking precedent. It may even occur in another hospital! In order to help structure this second survey and remember all the areas use the mnemonic: Unfortunately for Dr James Styner, it was a

H as My C ritical C are A ssessed P atient’s P riorities Or N ext M anagement D ecision

Head Maxillofacial C ervical spine C hest Abdomen Pelvis Perineum O rifices (PR/PV) Neuerological Musculoskeletal Diagnostic test/definitive care

strategy born out of tragedy. Dr Styner was an American orthopaedic surgeon who in 1976 crashed his light aircraft leaving his wife dead, and three of his children with critical injuries. Even though he received serious injuries he managed to flag down a passing car to take his family to the nearest hospital. It was here that he realised the void ATLS was to fill. The small hospital had no experience to deal with critical injuries and hence the care they received was disorganised, slow and generally poor.


PEER ASSISTED

Learning S

CHEME

Peer Assisted Learning is an invaluable way to “see one, do one, teach one” as Jenny Capps, 4th year medical student informs us

T

Action! - MRI students film Professor Davis performing a neck exam

he GMC’s 2006 guidelines on Good Medical Practice state that

towards the end of our third year. The OSCE’s in the third year are a

as doctors we should be willing to contribute to the teach-

significant step up in difficulty from previous years and we felt that

ing, training, appraising and assessing of our colleagues and

this scheme was just right to help the students understand what is

students. But, as medical students, how can we prepare ourselves for

now expected from them. We wanted to set up this scheme at MRI

this? The Peer Assisted Learning Scheme (PALS), now in its third year

to provide the year below with a structured way of picking up all the

at Hope hospital, offers an opportunity not only to gain these skills,

little pieces of advice and tips that we have found so helpful, or wish

but to pass on what we have learnt to fellow students.

we’d known a year before! Currently everything is falling into place

The aim of the scheme, (which is currently run by eight fourth year students),is to teach OSCE skills to third years in small interactive

ready for the MRI students’ mock OSCE in January.” As a third year, I felt that the teaching we received from the PALS

sessions. In Hope, the two skills currently taught are vascular exami-

sessions was some of the best we received all year, with a well-fo-

nation and examination of the neck. These were chosen because both

cused and interactive format. Having had such a positive experience,

have been examined in past third year OSCE’s, but there is currently

I was keen to become more involved, and I am now one of the fourth

no formal teaching of them. Each session is run by two members, who

years involved in running this year’s scheme at Hope. As well as the

after demonstrating and discussing the skill, provide the students with

valuable teaching experience I hope to gain, PALS has also allowed

a chance to practice with each other and ask questions. In addition, a

me to consolidate my knowledge about key examinations, and think

video is shown in which a consultant demonstrates the skill, providing

about the best ways in which to convey it to others.

a useful clinical insight and expert knowledge. Finally, each student who attends leaves with a handout summarising what has been covered in the session. The value of the PALS sessions to those approaching the first exams of their clinical years should not be underestimated. Not only does it provide them with teaching of two key examinations, it also gives them a better understanding of what will be expected in the OSCE’s, from an ‘insider’s’ perspective. This view is shared by two fourth year students at MRI, where current third year students can look forward to the arrival of PALS sessions. The coordinators, James young and Paul Whittemore said, “We heard about the Peer Assisted Learning Scheme at Hope Hospital

SOME TIPS FOR TEACHING A SKILL… „ Keep language simple and try to use bullet-points, diagrams and pictures. „ Keep the knowledge closer to ‘need to know’ than ‘nice to know’ – people can only take in so much! „ Try to make the session feel informal and friendly enough so that people are not afraid to ask questions, as it is often the questions that people worry are ‘stupid’ which others actually want to ask. „ Try to anticipate what questions people may ask. This avoids you getting caught out and also helps you to think about the subject in a different way. „ Apply the motto “See one, do one, teach one,” by letting everyone observe first, allowing time for them to practice, and then encouraging them to explain the skill to a friend, whilst offering constructive comments.

COMPETITION & DISCOUNTS

Mediscope has teamed up with H����� E�������� to offer three lucky readers a free copy of the popular book M�������� ��� S���� T��� ��� M������ S������� (2nd edition, RRP £8.99)

To enter, send in the best medical mnemonics that you can think of to competitions@mediscopeonline.com All entries will be sent a 20% discount code to be used online for all Hodder Education books. The best three entries will receive a free copy of the above book plus the best mnemonics will all be published in the next edition of Mediscope. Competition ends 31st March 2009. See www.mediscopeonline.com/comp.pdf for full T&C.


&

Making the Most of

educationscope

obstetrics gynaecology Fiona Mackie, 4th year medical student shares her experience of a somewhat daunting module HOW TO MAKE THE MOST OF Your PLaceMenT 1. Befriend the midwives and student midwives. They know a lot more than medical students about pregnancy and labour. Offer to make them a brew, ask questions, and above all, be respectful. These are the people you will spend your time with and therefore learn from. 2. Do a night shift. This shows the midwives that you are enthusiastic and they seem to be more accommodating towards you. It is less likely that there will be student midwives around as well. however, make sure you take some extra work to do as there can be a lot of waiting around, but it is worth it in the end. 3. Get into hospital 30 minutes before theatre sessions and try to consent all the women on the list for a vaginal and speculum examination under general anaesthesia. This gives you invaluable practice at these intimate examinations. Furthermore, you don’t have to worry about hurting the patient or feeling embarrassed. 4. go to as many clinics as possible. The issues you have to talk about in a gynaecology history are often quite personal and can be embarrassing. Therefore, it is useful to see how different doctors tackle these highly sensitive topics. 5. examine as many pregnant abdomens as possible. They feel completely different to the OSCE models.

O

bstetrics and Gynaecology (O&G) is an attachment students Aside from the pain, screaming and either seem really excited about, or the cocktail of bodily products that would prefer to skip entirely! Personally, accompanied the delivery, the thing I was really looking forward to it. that amazed me most was how, on I was expecting to see babies popmeeting her baby, the new mum seemed ping out all day and then, after a week or instantly elated, with her ordeal of two, maybe I would even get a chance to labour put well behind her. There were deliver. I was therefore quite disappointprofuse apologies to the midwife and ed when I discovered that we were only her partner, a few tears – from mum and assigned one week on the labour ward. dad – and then calm. In our first year of medical school With regards to gynaecology – I we watched a video of a home delivloved it! I attended at least four clinics ery, so although I had never seen a real and ten theatre sessions. Consent to be birth before, I was aware it was not a present was rarely a problem, for neither clean affair and my male clinical “At first it was strange seeing partner nor myself. certainly very vaginas... after seing so many I feared that we different to how in theatre, you quickly become would be asked it is portrayed in Hollyoaks! Howindifferent to them” to leave many ever, nothing can consultations, but prepare you for your first experience in in general, the women were surprisingly the delivery room with a woman in the obliging. throes of labour. At first, it was strange seeing vagiDuring the first labour I witnessed, nas. In GPs, patients often ask students the mum-to-be had progressed so to leave if the consultation is one that quickly that there was no time for her involves genitalia. After seeing so many planned epidural (a form of anaesthesia vaginas in theatre, you quickly become injected into the spine). She was indifferent to them. screaming all kinds of unladylike O&G is known for being one of the obscenities that could be heard all the more hands-on attachments and this way down the corridor. After two hours, was certainly true. We scrubbed up in the baby’s head started to appear – it theatre and even had opportunity to was nearly time. As the head emerged assist. Although, for the main part, we further, I became increasingly concerned were just holding vaginal instruments as to how something that big was in position! However, some of my going to fit through a hole that small! friends had been asked to assist during Following the help of an episiotomy, a C-sections and the insertion of coils, so small cut into the perineum, the head generally getting involved whenever was finally out. A couple of contractions possible! later, the body followed and the baby Even if you are not looking forward to girl was whisked onto the mum’s naked your O&G placement, you cannot deny chest. What immediately followed was that it is a privelige to see the ‘miracle of that distinctive newborn baby cry. life’. I am sure you will be astonished by it. 01/09 mediscope

19


educationscope

Breaking Bad News

No one likes to hear bad news but Bryony Clarke, 4th year medical student passes on some valuable lessons on how to break it gently

“I

 ’m not saying this is the end of the road...because it might not be” was the attempt of one of

my peers to console the simulated patient just diagnosed with multiple sclerosis. The thought was there, but in the heat of the moment, under the watchful eyes of eight of your peers and a tutor, it is not easy. My turn in the hot seat was none the better. Feedback included that, had I leant in any more empathetically, I might have been sat on the patient’s lap. 10/10 for effort! It is estimated that an oncologist will break bad news up to 20,000 times during their career. It is however, a task that befalls doctors in all specialities. Doctors should be skilled communicators and this is never more important than in the breaking of bad news to a patient. Therefore, it is imperative that as medical students we begin to build an awareness of what makes a good consultation when breaking bad news in order to provide foundations for future good practice. Hippocrates advised “concealing most things from the patient while you are attending to him. Give necessary orders with cheerfulness and serenity… revealing nothing of the patient’s future or present condition. For many patients… have taken a turn for the worse…by forecast of what is to come.” This outlook is in stark contrast to today’s approach of being frank and honest with patients, by providing as much information as they want or need ‘in a way that they can

20 mediscope 01/09

understand’.

The SPIKES approach: Setting and listening skills Patient perception invitation Knowledge explore emotions and empathise Strategy and summary they may feel dissatisfied. This model

The old school approach of dropping

also touches on the need to identify and

bad news into conversation on the ward

deal with emotional responses. However,

round, between discussing the weather

this is a simplified model and there are

and being interrupted by Mr. Jones

other things that are worth considera-

asking when it is his turn, is hopefully

tion including: The importance of hope

long gone. Now is the era of the multi-

and expressing sympathy. Follow up is

disciplinary team approach. The patient

also reassuring: “If it is ok with you I am

should be prepared, difficult information

going to come back and see how you are

sign- posted and the news sensitively

tomorrow”. Written information for the

discussed, without giving false hope. Not

patient to take away is of great value as

an easy task given that no time is a good

well as having a specialist nurse at the

time for bad news.

consultation.

By paying attention early in our train-

In time we will all develop our own

ing and taking opportunities to observe

style and in reality, each patient and

doctors breaking bad news, we can build

consultation is different. It is easy to

up a bank of experiences which we can

think that as medical students we have to

later draw upon in our own practice. While we

“no time is a good time for bad news”

take a back seat, since the line “I am sorry I cannot

are students we may also have opportuni-

answer that, I am just training” has been

ties to ask patients afterwards how they

drummed into us! Although we are train-

felt or what they would have liked to have

ing, we are often well placed to talk to

been done differently. In terms of more

patients after bad news has been given.

hands on learning of this subject, commu-

While not qualified to provide informa-

nication skills sessions in year 4 are a good

tion about the condition or treatment, the

opportunity to practise breaking difficult

patient may just appreciate someone tak-

news, and if there is ever a time to get it

ing the time to ask how they are doing.

wrong or say something silly it is now...

It may feel like working as a doctor

you can’t hurt a simulated patient! Note:

and having the responsibility of breaking

this is not an invitation to try!

bad news is a long way off. However, we

This protocol provides emphasis on

have a duty as part of our training to pre-

the need for privacy, time and exploring

pare ourselves. This can be through ob-

the patients’ current understanding. It is

servation, talking to doctors, patients and

easy as doctors to imagine what we might

other professionals and practising in skills

like to know. Patients may have a very

sessions. And you never know, it could

different agenda and if this is ignored,

even make a good piece for portfolio!


AGONY U N T S

The sweetener for all of your bitter problems

educationscope

this issue candy solves matters of the heart

D� ��� ���� � �������� ���� ��� ���� ��� �� � �������? W�������� ���� ��������� ��������? S������� �� ����... O�� �������� ����� ����� ��� ���� ���� ��� �������.

Dear D-grade in GCSE English .

Dear Aunts,

Need help Dudette! Im a third year medic and Im working the cardio rotation. I want to be a cardiolagist, it suits my personality. Prob is, on the ward rounds when the boss asks us to ‘listen in’ to murmurs and sounds - I just cant hear that mytral valve or whatever he (and all the others) blah on about. What to do??

Major Dude Ps. is that mytral valve thing in my stethie?

Illustrations by Prizzi Zarsadias

Try taking the MP3 Player out!

Cyneek

Ps. you need humanising….drop the job in the Games Workshop and get a girlfriend !

Dear Student Doctor, Cyneek is being unduly harsh. It’s really not that necessary to be grammatically correct and be a doctor these days. Back to the problem in hand. My advice is to ask the cardiologist concerned to spell out what it is he (often, well actually nearly always – I wonder why that is, hmmm maybe there is a research project in there!) is actually asking you to attend to Is it the lubb or the dubb or the shhh or the whoosh? That way you can break down the task and tackle parts of it at your own pace without it getting you down. you could always look at the Auscultation Assistant website www.med.ucla.edu/wilkes which gives you heart sounds to listen to in your spare time. Once you have mastered them in these less stressful situations then you can crank up the pressure and do it on the ward round. I can’t emphasise enough how important it is for you NOT to be stressed out about this. Remember what happens to people who are stressed? …that’s right, they don’t process information very well do they? Do you think you are stressed? Is this the real problem? I think not, as nothing much happens in the 3rd year so it’s not likely to be that, however… At each stage of the learning process you need feedback, so ask him nicely if he can give clear and concise feedback on your performance after each attempt. He will have been trained especially in being tolerant and respectful of students and will be only too glad to help with these important parts of his job.

Start as you mean to go on – financially secure

• Free cover through your final year • Income protection • Educational events • Free final year photograph • Sponsorship • National Medics’ Hockey Tournament • Mortgages • Savings • Personal property insurance • Travel insurance

Wesleyan Medical Sickness understands that life as a medical student is hard work and that planning your financial future is possibly the last thing on your mind. Our designated team of Student Liaison Managers can provide information on free income protection cover through your final year, and are on hand to point you in the right direction with any financial queries. They will be holding presentations in your school, helping with sponsorship for school clubs, societies and events, such as your Graduation Ball. They will also be co-ordinating your group photo, which we provide to all final year students as a free gift when you qualify. To find our more on how we can help you, please contact your local Student Liaison Manager.

Freephone

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Just as a wee bit of advice, it may be an opportune moment to ask when he has been called in to see a private patient, often on a Saturday, as he will have spent some time that day relaxing on the golf course so he will definitely be more receptive to important requests like this. Best not to call him out of an ablation procedure, it can probably wait.

Love and every good wish,

Candy xxx 01/09 mediscope

21


22 Highway to Helmand 23 careerscope Sports & Exercise Medicine 24 European Working Time Directive

careerscope With assistance from Colonel Thornycroft (army career advisor for Northwest England), Captain Damian Keene (Birmingham Medical School graduate) and Captain Matt Campbell (University of London Medical School graduate); Ahmed Hankir and James Goodman write about whether being an army doctor could be the career for you.

S

HIGHWAY TO HELMAND

tudents at UK-based medical

way as their fellow officers. Where an

found myself in the (40°C) heat of Hel-

schools may apply for an Army

army doctor is deployed (whether in the

mand. The tour was everything I’d both

Medical Services (AMS) military

UK or overseas) depends largely upon

hoped for and feared. I was living a basic

cadetship in the final three years of

their medical interests and abilities and

existence in forward bases, with a band of

medical school. Military cadetships offer

involves facing a wide range of situations

combat medics providing both primary

a comfortable salary, far in excess of the

and medical conditions, most notably

and pre-hospital trauma care to an infan-

typical student grant and it is a decision

trauma cases in the young. In recent

try company group of 130 soldiers. It’s

that few students regret. Military cadet-

times, army doctors have also been in-

fair to say that the frequency and severity

ships are, however, binding, requiring

volved in UN and NATO peace keeping

of trauma we saw was unlike anything

a commitment to five years of military

and humanitarian operations.

back home. As well as providing sound

service on completion of FY2. The AMS

By joining the Army as a medic, you

medical testing, my newly-acquired mili-

offers students special elective place-

implicitly offer your skills and support

tary skills were frequently stretched as I

ments to trauma centres and military

to those who are prepared to offer their

supported patrols and deliberate opera-

hospitals overseas.

lives. Colonel Thornycroft adds, “when

tions. In addition, I spent time working in

‘Real’ military training begins fol-

soldiers put themselves in harm’s way

the UK field hospital, in primary care and

lowing FY2 and a further two years

for the sake of others, doctors are often

on the helicopter-borne Medical Emer-

experience is necessary before specialis-

inspired to help them.”

gency Response Team.”

ing. Throughout this period, unrivalled

So what are the disadvantages of join-

We would like to thank Colonel

opportunities for travel and adventure

ing? The role can involve being sent any-

Simon Miller at the Royal Army Medical

exist, as Captain Damian Keene reports,

where in the world, sometimes at short

Corps for proof-reading this article.

“I have had lots of opportunities to take

notice. Potentially long and irregular

part in adventurous training, initially

hours during operations can entail being

in the Royal Air Force and Royal Navy.

snowboarding and then two weeks kay-

apart from your family for extended pe-

For further information on a career as a

aking in Bavaria.” Additional advantages

riods. Finally, there is the worry (usually

doctor in the army, please visit:

include the funding of medical courses

unfounded) about returning to work

and membership examinations.

within the NHS.

The range of specialities available

Dr Campbell explains, “after the

in the Armed Forces sector is similar to

hugely enjoyable Professionally Qualified

those in the civilian sector. Doctors in

Officers’ course, I was posted as a Gen-

the Army are officers as well as medical

eral Duties Medical officer to 4 General

specialists and therefore must demon-

Support Medical Regiment before they

strate leadership in exactly the same

were deployed to Afghanistan. I then

22 mediscope 01/09

Remember, doctors are also required

http://tinyurl.com/8u6jds

Did you know?

„„ Roger Bannister (the first man to run the mile under four minutes) did his National Service in the Royal Army Medical Corps. „„ Sir Alexander Fleming, the discoverer of penicillin, served as an Army doctor during WW1. „„ Rob Wainwright captained the Scottish international rugby team while serving as a doctor in the RAMC.


H

ow many of you cringe at the sight of your team’s best player being stretchered off after a horrific tackle that threatens their career? Do you anxiously check websites to see if your favourite athlete is going

to be involved in their next event? If this is you then read on... Sports and exercise medicine (SEM) involves the medical and surgical treatment of all those involved in sport; from those who have a weekend kick-about, through to elite athletes competing at international level. SEM is more than just the management of injuries; it also includes planning fitness regimes to optimise performance, facilitating training when competing in foreign environments, dealing with psychological demands and knowing how to cope with the full range of medical problems which may befall an athlete! One must also communicate effectively with medical and physiotherapy personnel and believe in your own judgement when under pressure from the public and managers. Our first event was a Q&A session with Dr Mike Stone, former Manchester United team doctor, who currently works for the England cricket team and the English Institute of Sport. Interesting issues included confidentiality involving high profile sportsmen/women and the conflict that can arise between the needs of a patient versus the demands of a club. Dr Stone reinforced the idea that most of his time was spent dealing with the daily needs of the players, treating anything from a bout of flu to arranging urgent imaging for one of the world’s highest paid athletes. He also pointed out that everything needs to be carried out at speed as getting athletes recovered quickly is vital. Being a team doctor can be very time consuming, involving lots of antisocial hours. Following the success of our first event, we organised a “Sports and Trauma” first aid day with over 70 people taking part in November 2008. Future events include talks on SSCs, Project Options and electives concerned with SEM.

SporTS

&

Se I c r e eX by david

ormesh e

e N I c I MeD r & lesley mckee

LEFT - delegates learn the techniques of spinal immobilisation and wound management after an athlete crashed their bicycle on track

RIGHT - delegates at the trauma course dealing with multiple casualties after a fall from a climbing wall If you need any further information or are interested in joining the society then please visit our website www.sportsmedicinesociety.org.uk you can also contact any committee member through our Facebook group (Search for Sports and Exercise Medicine Society). Illustration by Raul Orozco


careerscope

The European Work

AUGUST 2009 APPROACHES AND WITH IT COMES THE EUROPEAN WORKING TIME DIRECTIVE (EWTD) AND THE PROMISE OF A 48 HOUR WORKING WEEK FOR JUNIOR DOCTORS. THOMAS KELLEy, 4TH yEAR MEDICAL STUDENT, EXPLORES THE IMPLICATIONS THIS HAS ON MEDICAL TRAINING AND PATIENT CARE

T

he EWTD was first

challenged by the EWTD because

introduced for European

of the reduced time-availability of

Union member states in

trainees and the limited opportunities

1993 and was enacted in the UK in

for communication and training. It

1998, with the principal aim being

is clear that junior doctors have less

to protect the health and safety

clinical exposure and experience than

of workers. However, doctors in

their counterparts in the past. One

training were exempt, that is, until

surgeon has commented, “I have

2000 when an amendment to the

three operating sessions per week

directive was made that it should

and I want my junior there with me

also apply to them by August 2009.

so that I can give him the hands on

A study looking at anaesthetic

training. But they can’t be with me

specialist registrars (SpRs) and Senior

because they’re on call that day. Then

House Officers (SHOs) demonstrated

the next day they’re off and they’re

that the EWTD has resulted in a

not allowed to join me voluntarily

20% reduction in their case load. In

because they’ve been asked to

addition, the consultant in-theatre teaching load was also shown to have decreased by 22%. However, these statistics are not surprising given the extent of the working hour restriction. What is important is that quality is maintained. Therefore, the authors of this particular study were advocat-

go home. How am I supposed to

ing a move away from “time based

give him the hands on training?”

assessment” to competency based

(Tsouroufli and Payne, 2008).

assessment (Waurick et al, 2007).

24 mediscope 01/09

“it is clear that junior doctors have less clinical exposure and experience than their counterparts in the past”

The apprenticeship model is

The apprenticeship model is

still favoured today by trainers and

what has traditionally been used in

trainees alike but, due to the EWTD,

UK medicine and clearly has been

no longer works as well as it once

effective given the competency

did. The backbone of medical care

of the majority of senior doctors

in the UK has been the ‘firm’, which

today. However, it is being greatly

has traditionally consisted of a house


king Time Directive

careerscope

by Thomas Kelley

officer (resident), an SHO (resident),

introduced against the wishes of its

48 hours per week is radical and

a registrar (resident), a senior

supposed beneficiaries.

damaging to the medical profession.

registrar (resident) and a consultant (attending). This is an excellent

On the other hand, an Italian ophthalmologist believes that the EWTD

system for continuity of care as the same group of doctors admit and care for a particular patient. It is also excellent for training, as doctors will see the patient from admission to discharge and this clearly supports the apprenticeship model. With

Even if it does focus training and we continue to adopt competency based assessment, one simply cannot

“The majority of these doctors felt that the eWTD would have negative eects on clinical exposure, training and patient careâ€?

replace clinical experience and on the job clinical training; both of which are compromised by the EWTD. I fully agree that systems need modernising, but what I do not agree with is the extent to which the EWTD

EWTD-compliant rotas, this firm

is an excellent way for the British

has changed British Medicine. We

system is no longer possible.

NHS to modernise its system. He

all know the importance of getting

goes on to explain that a better man-

to know a team of doctors; once you

primarily been introduced to protect

aged, better structured and more in

get to know each other the working

the health and safety of workers,

depth training programme will lead

environment generally becomes more

studies have shown that actually

to a more focussed and meaningful

pleasant and they are more likely to

the majority of doctors are opposed

training for physicians (Nucci, 2006).

teach and support you. However,

Although the EWTD has

to these changes. A study by the

Furthermore, Norway is not

with medical teams becoming ever

Royal College of Physicians showed

part of the European Union, but

more fragmented along with the

that out of the 970 SpRs that they

is a country that has traditionally

current evidence in the literature,

interviewed, 78% would prefer to

had low working hours. In fact, the

I fear that our training will be

work an on-call rota rather than a full

general working week of a hospital

damaged and that enjoyability may

shift system. Morris-Stiff et al, 2005,

doctor in Norway is 38 hours,

well be reduced.

found that 88% of surgical SHOs,

although they are able to consent to

100% of surgical SpRs and 96% of

working up to 50 hours. These hours

medicine and therefore, with a huge

surgical consultants were opposed

do not seem to have had a negative

number of studies showing lack of

to the introduction of the EWTD.

impact on patient care; be that due to

support for the EWTD, then surely

The majority of these doctors felt

a lack of continuity or a lack of doctor

we should modify it. Will it yet again

that the EWTD would have negative

competence (Waurick et al, 2007).

take several serious adverse clinical

effects on clinical exposure, training

It is clear that working 100 hours

We are in an era of evidence based

events before the healthcare planners

and patient care. Therefore, it would

a week is excessive and perhaps

take note of what is undoubtedly a

appear that the EWTD is being

not safe. However, a reduction to

mistake? 01/09 mediscope

25


26 A Bitter Pill to Swallow 33 yourscope A Hospital in Lebanon 35 YourScope Q&A

Uncertainties OVER the prescription of expensive treatment has placed the core values of the NHS on precarious ground. Lily Wheeler, 3rd year medical student, unravels the background to the controversy.

yourscope

A

What has happened?

Bitter Pill to Swallow

by Lily Wheeler

I

between NHS and private healthcare for

refused drugs such as Cetuximab and

What is being proposed?

n recent months, cancer patients and their entitlement (or lack of) to life

prolonging drugs has dominated the

media. We have seen terminally ill patients Lenalidomide, which may have given them an extra six months to live, because NICE

(National Institute for Health and Clinical

these patients. This new report contains

recommendations for the NHS, Department of Health (DoH) and NICE.

T

he findings in this report have led to the formation of a set of draft

guidelines by Johnson and NICE.

Excellence) and the NHS have deemed these

The new measures mean that a greater

themselves, they lose the right to any free

process.

drugs too expensive to fund. As the law

stands, if these patients pay for these drugs NHS treatment and care. However, by the

end of this month, this is likely to change. In November 2008, Health Secretary,

Alan Johnson, announced that where

a patient chooses to pay for additional private treatment, the free NHS care

must never be withdrawn, as long as the principle of separateness is adhered to - a decision made in response to the

number of drugs will become available

on the NHS, through a speedier appraisal

Commenting on the guidelines, Johnson

has said that, “a greater range of more

expensive therapies will be available to

What other issues are up for discussion?

R

ichards also addresses the

principle of separateness, which refers to the differentiation

between public and private healthcare. Guidance contained in two reports –

‘Management of Private Practice in Health Service Hospitals in England and Wales’ (1986) and ‘Code of Conduct for Private

Practice’ (2004) – both state that a patient cannot receive both private and state-

funded healthcare for one condition during a single visit to a hospital or clinic. This

guidance has resulted in the denial of free NHS care to patients who wish to pay for

NICE can take up to ten months to make recommendations. If NICE gives a positive appraisal, the drug will be recommended for NHS use. If not, a PCT can fund the treatment, although this loophole has since generated debate over the resulting ‘Postcode Lottery’

“distress to patients and their relatives”

more patients on the NHS – reducing the

medication unavailable on the NHS. The

the larger debate on accessibility to

choose to pay for additional drugs not

patients, regardless of whether they opt

that these “uncertainties” have caused. This decision has arisen as part of

medication, which Professor Mike Richards has addressed in his report entitled

‘Improving Access to Medicines for NHS Patients.’ The report reviews the NICE

and NHS guidelines on end-of-life drugs

and the protocol surrounding the conflict

26 mediscope 01/09

need to seek private care.” He went on to

say, “A small number of patients may still available on the NHS. But I have agreed that, from today, NHS care must never

be withdrawn in these cases – as long as

private treatment takes place in a private

facility.” These draft guidelines will be open

to consultation until the 27th January 2009.

recent statement from Johnson concerning the provision of free NHS treatment to all

for additional care elsewhere, is hoped to

alleviate the fears and concerns of patients and restore faith in the health service and its principles of fairness, equality and universal healthcare for all.

NICE is the government body charged


A hospital in Lebanon yourscope

with appraising new drugs and assessing

cost-benefit ratio of these medications.

performed and a recommendation is made

NHS in the perverse position of charging

whether they are of benefit to patients. If

deemed beneficial, a cost-benefit analysis is as to whether they should be available

on the NHS. The entire process can take

up to ten months. If NICE gives a positive

appraisal, the drug will be recommended for NHS use. However, if NICE rejects the drug, a Primary Care Trust (PCT) can

nonetheless fund the treatment, although this loophole has generated debate over

the resulting ‘postcode lottery’. DoH has

Richards rejects the notion of NHS top-

up fees in the belief that this would put “the

A tale not full of woe from the war-torn lands of Lebanon: Mediscope editor Ahmed Hankir frames his thoughts on the power of dreams.

for treatments that have not been deemed as cost-effective.” Similarly, Richards

maintains that the NHS cannot bill patients

It is widely agreed that drugs

M

that extend life by even a few months are highly valued by patients and their families

y father, Dr Zachariah Hankir, a Consultant in Obstetrics and Gynaecology, currently

practices medicine in Sidon, Lebanon. I

declared that the body takes too long

for healthcare that would and should be

was in Sidon not so long ago in July, 2008.

the continuation of support to NICE in its

breach core NHS values. However, patients

seize the learning opportunity. As soon as

long as this is carried out in a separate

and director of Kassab Hospital.

argue that the measures will undermine

rich and famous. However life was not

wealthy patients would receive better

this self-made man.

this may be the only way to ensure fair

says, “I knew that I

to make these recommendations. In

response, Richards’ report has advocated efforts to speed up its appraisal process. Consequently, NICE has initiated a five-

week public consultation on changing its appraisal process.

A further matter highlighted by

Richards’ report is the need for greater

flexibility by NICE, the NHS and the DoH

when determining the value of drugs that extend life in terminal illnesses and their

availability on the NHS. It is widely agreed that drugs that extend life by even a few

months are highly valued by patients and their families. Furthermore, there have been numerous stories of patients and families re-mortgaging their homes in

order to pay for these treatments. Accord-

ing to the Rarer Cancers Forum, it costs an

average of £20,831 for an unfunded cancer drug. He thus recommended that the DoH and NICE work together to re-assess the

available on the NHS, nor can it fund private

One sunny summer morning I decide to

should be allowed to fund unavailable

I step foot inside, I notice a distinguished

environment to their NHS-funded care.

On questioning Dr Kassab, I conclude

healthcare with public funds, as this would

accompany my father to the hospital to

treatments themselves privately, as

gentleman- Dr Walid Kassab: founder

the NHS, transforming it from a universal

always rainbows

care than their poorer counterparts for

“I started off with

distribution of NHS resources.

always wanted to be

system into a two-tier system in which

and butterflies for

the same condition. Others are saying that

nothing”, Dr Kassab

?

? ? ? ?? ?

?

?

? ? ? ? ?Michael?Chu ? ? ? ?? ? ?? ? ?

- Year 1 “Mummies and daddies curry night! I was able to get to know my ‘parents’ as well as my fellow PBL members, having a lot of fun in the process”

a doctor. It was my dream and I set out to realize that dream”. Dr Kassab speaks

Thumbs up for top-up or two-tier

with an English accent, courtesy of his

too much? Mediscope welcomes

specialist training in Paediatrics at Great

readers to share their own point of

Ormond Street Hospital, London.

view on this hot topic

I asked Dr Kassab what the key to

Email - articles@mediscopeonline.com

Your S cope Q+A ? ?? ? ?

that his lifestyle is reminiscent of the

Opposition to the new proposition

his success was; he enlightened me by saying that it was his unshakable selfbelief that gave him the strength and stamina to work up to 20 hours a day.

   What has been your greatest    highlight in the past semester?

?

?

?

?

?

Eloise Bill - Year 5 “Having a free massage as part of the Alternative Therapy teaching at Christie Hospital!”

Literally every penny Dr Kassab earned went straight towards buying the land and building the hospital. Today, Kassab Hospital, the realization of his dream, is one of the leading hospitals in the South of Lebanon. Dr. Kassab kindly adds, “We welcome medical students from Manchester Medi-

Sotonye Tolofari Intercalating

“Probably the first time I looked down a microscope and realised that cells were art”

cal School to do their electives in Kassab

Hoshang Farhad - Erasmus

“The pub crawls: Pyjama, golf, Christmas. It is a unique way to party and drink that I have never experienced before and will surely remember for a long time…”

Hospital.” For those of you who are inter-

?

?? ? ? ??? ?

?

? ? ???

Correction: In issue 3 (Sep 08), page 14, Mediscope incorrectly credited Selina Ahmed as the sole author. We would like to give further credit to the co-author, Waheed Ahmed, and Dr Gwen Ayers (Consultant Toxicologist) for proofing the article.

ested in doing your electives in ‘the Paris of the Middle East’ do not hesitate to contact me. This is a learning opportunity you really can’t afford to miss. 01/09 mediscope

27


28 Medsin societyscope 28 Medical Students’ Charity 29 Medical Debating Society 29 Chernobyl Children’s Project

medsin - Tom Callender, Year 2, Medsin Manchester President

P

ublic health is never out of the headlines for very long. From comments suggesting that recession may be good for our health, to 11,700 cases and 500 deaths registered from cholera in Zimbabwe in the last four months, we are surrounded by constant problems at both a national and international level. Many students feel that there is little they can do about the issues surrounding them, or are unaware of how to put their ideas for solving health issues into practice. Our challenge is to tackle this. Medsin is designed to act as a platform

societyscope whereby students with project ideas regarding healthcare issues can seek advice on their proposals. Our goal is to use our skills, funding and contacts to help get these projects up and running! This autumn we have focused on initiating Sexpression (designed to teach sex education in schools throughout Manchester), MOSS (designed to combat the loneliness and isolation felt by some members of the elderly community) and the Organ Donor Campaign. Meanwhile, Medsin’s more established projects, such as Marrow and Homed, continue to be very successful. Recently we have run the Red Party, the now infamous

event, with the aim of promoting safe sex and keeping alive the issue of HIV and AIDS. In the New Year we are planning to hold a series of talks with doctors and lawyers to discuss health issues from different perspectives. If there are particular areas that you feel you would like to hear about, please get in touch and we will organise it. Finally, the biggest Medsin event of the year, the Global Health Conference (GHC), will be held in Manchester on the weekend of March 27th 2009. The aim of the GHC is to create an interactive forum to debate and discuss vital health issues. We hope this will both inform and inspire action. With a little enthusiasm and dedication, it really is possible to achieve a great deal as students. So choose action over apathy!

MMSC

Manchester Medical Students’ Charity Andrew Cheng, Year 4 MRI, MMSC President

“CHARITY COOKIES! ONLY 20 PENCE!” is the call that most hung-over freshers love to hear being screamed at them on their first day of medical school. Thankfully, the MMSC were decent enough to step up and oblige. This year, a new committee of eager volunteers were appointed to run the MMSC. With the changeover came a new drive to expand the society’s audience and influence, whilst maintaining our original ethos of making fundraising... fun! We have

already exceeded all expectations by raising £1450, and we are only half way through the year. Deciding upon our charity this year proved difficult, with such a variety of great charities based within Greater Manchester. After long deliberation, we decided upon Talbot House, a local charity providing support for parents of children with severe mental and physical disabilities. Our annual third year curry allowed the St Andrew’s students to taste

Manchester student life - literally. We also put our home-baking skills to the test by holding a cake sale at the medical freshers’ fair. Of course... we sold out. We had an overwhelming response when we hosted our first ever pub quiz at Robinski’s in Fallowfield. With questions like “Why do men have nipples?”, it was obvious that a medics team would win. Congratulations to team ‘PBL8 iz GR8’ consisting of second years; Sophie Yelland and Josh Hurst with


societyscope manchester medical debating society - Osman Hussain, Year 1, MMDS Founder

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injury was related to alcohol and where the liability for that injury was. Once the issue of the practicality of charging patients money for medical treatment was raised, the majority of individuals felt that it went against the idea of the NHS system and our role as doctors. This caused a number of those undecided to switch to the opposition’s side and consequently won them the debate with the motion defeated.

he second debate of this semester, held by Manchester’s Medical Debating Society, proved to be one which sparked a lively discussion. The motion, ‘This House proposes to charge medical bills to patients who present with alcohol related injuries’, was argued competently by both sides. The fact that the two teams discovered which side of the floor they were arguing only ten minutes before the debate, by virtue of a coin toss, meant that all speakers had to think quickly and adapt their arguments accordingly. This was impressively handled by both teams. The initial vote saw the majority of the floor undecided with a few on either side. The real contest began when the audience presented their questions and opinions. These ranged from those quoting the Hippocratic Oath to those questioning the economic impact of such a proposal. The major talking point, and one which ultimately decided the contest, was regarding the assessment of patients and how one would ascertain if an

hernobyl Children’s Project (CCP) is a registered national charity. Its principle aims are to improve the lives of children in Belarus who have been affected by the Chernobyl nuclear disaster and to raise awareness of the disaster and its consequences. The charity has 30 groups across the UK who organise families to host sick and disabled children from Belarus. The charity also runs projects in Belarus

their ‘fresher children’; Joanne Skinner, Nathan Hunter and Lydia Vogelaar-Kelly. They took home two crates of Strongbow, big smiles, and a massive amount of respect. In November we held the first of our infamous OSCE revision sessions, which was the most successful event to date, raising over £600. Special thanks to all those who presented - you were great. Lastly, congratulations to ‘70 stones of pure footballing power’ for clinching the MMSC 5-a-side Champions Trophy on

a bitterly cold Sunday morning. If you have not heard of the MMSC until this year, we really hope you all have by now! We have great events coming up: a spring raffle full of mind-boggling prizes, paintballing, the summer 5-a-side football tournament, more curries and more pub quizzes! We will also be hosting the remaining third and fourth year OSCE revision sessions and are currently considering running them for first and second years. Finally, we are looking for adventurous (or

chernobyl children’s project - Jessica Collins, Year 3 Hope & Jonathan Helbrow, Year 3 Preston

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such as respite care centres and children’s homes. Here at Manchester we have a student branch of CCP. Our focus is on running a recuperative summer holiday camp in Belarus for mentally and physically disabled children from two orphanages. At the camp, volunteers run simple activities for the children involving sports, art and games. In order to achieve this, CCP Manchester fundraises throughout the year by organising parties, bag packing, music events, cake sales, sports tournaments and sponsored events. Past events have included the renowned Superheroes and Villains Party and Radioactive Live – an all-day band event showcasing local artists. If you would like to get involved with CCP, we meet every Tuesday at 7.30pm in the bar at Owen’s Park. EMAIL - ccpmanx@gmail.com web - www.chernobyl-children.org.uk

possibly borderlinecrazy) medics MM to run with us in SC the Bupa Great Manchester 10K Run. If anyone would like to help out with any of the events whilst having fun with a great bunch of people, please don’t hesitate to email us. You can track our progress on our new website. We wouldn’t be here without your support, so we hope to see you at our next event!

EMAIL - info@mmsc.org.uk web - http://www.mmsc.org.uk


john lumley

DIY clinical forexamination medical students

30 Pastest DIY Examination reviewscope 30 Bad Science & Competition 31 The Constant Gardener

bad science by ben goldacre - Catherine Taylor, Year 4, Royal Preston Hospital

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en Goldacre works as a doctor for the NHS, but is best known for his weekly column in the Guardian, entitled ‘Bad Science’, which is also the title of his new book. Both aim to uncover the truths behind some of the biggest media frenzies surrounding medical issues. Ben manages to unravel some of the biggest media fiascos seen in the medical world. He devotes a whole chapter to the MMR controversy, which still has huge ramifications today; 25% of children in the North West are not immunised!

30 mediscope 01/09

reviewscope pastest diy eXaMination by john luMley - Ranjit Bains & Alessandra Sorrentino

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Iy Clinical Examination for Medical Students is suitable for those at any point on the medical course. It proves a helping hand for those in their pre-clinical years, given the pertinent review of clinically focused anatomy and is equally informative for clinical students, with consistently helpful explanations of the signs to look out for during patient examination. The most helpful asset of this pocket-sized book is the storyboardlike series of images littered throughout the chapters showing the correct approach to examination. It is second only to being shown by someone in-person how to elicit each sign. Underlying anatomy is superimposed onto what the typical student often witnesses in the clinic,

The book is aimed at the general public; you don’t have to be in the healthcare profession to understand the terminology or the ideas. It is clearly written, allowing you to easily follow the reasoning. Subjects range from what makes a clinical trial a fair trial, to how the methodology used by the researchers should always be taken into account before deciding how much weight the results carry. I think everyone would learn something from this book. He has opened my eyes to some of the tricks of the trade used in trials to skew results and the lengths the media will take to stir controversy.

5/5

£12.99

ISBN:978000724019 www.badscience.net

helping to visualise the important structures underneath the area in question. Budding surgeons will appreciate the parts devoted to surgical aspects. This is not just a guide for scraping through. The detail is ideal for those aiming for commendable OSCE marks and at the same time, is accessible for the student who has never been near a patient with a tendon hammer before! We soon found ourselves frantically thumbing the index between teaching sessions to learn about an obscure sign we had just seen. Clinical examination and clinically focused anatomy is presented in an attractive and easily digestible format. This book is, in short, an indispensible guide to clinical skills, history taking, and examination.

4/5

£23.99

ISBN:9781905635515

comPetition

We have a brand new copy of Bad Science to give away. All you have to do is tell us your best (or worse) home-remedy, whether useful or not! Email your answer no later than 1st April. Maximum 200 words. Winning remedy will be published in the next issue. good luck! competitions@ mediscopeonline.com

mediscope


the constant Gardener

reviewscope

a HIGHLY aCCLaImed FILm FRom FeRnando meIReLLes, THe aCademY aWaRd nomInaTed dIReCToR oF CITY OF GOD

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ith the recent release of Blindness, the director, Fernando Meirelles, has again resurfaced with a valiant effort. But, since only medically related articles can be printed in this hallowed magazine, another one of his celluloid works is up for critical delectation. The Constant Gardener, Meirelles’ first English language film after the brilliant City of God, is a love story, conspiracy thriller and social commentary rolled into one. Justin Quayle (Ralph Feinnes), a quintessential no bollocked Brit working for the British High Commission in Kenya, is suddenly thrust into turmoil after being informed of the tragic death of his beautiful wife, Tessa Quayle (Rachel Wiesz). Tessa is a feisty woman, whose death occurred under suspicious circumstances when investigating a multinational pharmaceutical company named “Three Bees”. From this introduction, we have a sprawling narrative cutting in and out of Justin and Tessa’s romance and Justin’s

by yuran ZhenG present day search for answers to his wife’s death. The film is essentially a love story, showing us the somewhat unlikely development of how this timid gent and fiery young woman came to be together, and the lengths to which Feinne’s character will go to find out how his wife died. Meirelles doesn’t leave it there and weaves so much more detail into the film. It is almost an ode to Kenya. His scenes depict an incredible bright and colourful backdrop of characters; all beautifully shot with his camera slowly ruminating

thE pharmaCEutICal CompaNy Is thE “galaCtIC EmpIrE” to QuaylE’s “rEpublIC” on scenery, making Europe appear a wretched grey concrete jungle. The pharmaceutical company is the “galactic empire” to Quayle’s “republic”; a towering mass of unstoppable western power. you hate these people from the bottom of your

heart and, having watched the film, I wanted to immediately trash every stall that had a pile of nice white sticky labels and pens on them. you���re drawn into the complex thuggery that this company is getting away with and forget about the basic character study of a man losing someone he truly loves. My only quip is with the stereotypical portrayal of the British characters. “Dear boy” was thrown about a few times and it made me wonder whether I should be greeting more people with this line. Meirelles has constructed a great film about love, loss and greed. It doesn’t bore you with soppy rubbish, but is more about Kenya and similar nations, its people and the immense control multinational pharmaceutical companies wield over them. It is about a man’s unrelenting pursuit to lay his loved one’s memory to rest.

4/5

01/09 mediscope

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Mediscope Magazine - Issue 4