Northwing 2010 by Northwing Magazine

NORTHWING

Celebrating 75 years

May 2010

EDITORIAL This edition of Northwing marks a very special occasion—its 75th anniversary. For 75 years students have been putting together a magazine that celebrates the joy of being a medic. Knowing that, putting together this edition of Northwing evoked a sense of trepidation. We all wanted to make sure that this edition of Northwing was something special, something different that connected the past to the present. The process has been lengthy and we definitely had hoops to jump through but finally after almost year and half it has finally come together! We hope that when you read this edition of Northwing you get a feeling of how it is being a medic in 2010 and how that may not be so different from being a medic in 1935!

we’d like to take this opportunity to thank everyone who did put something into this issue. It’s definitely been a team effort and we couldn’t have done it without you. Thank you.

Back in the day Northwing was a regular winner of the BMA prize. However these days the desire for prizes seems to be abated and you are more likely to be met with apathy - “Well I’m just no good at writing.” We’re not looking for Shakespeare. But surely being able to write is an essential skill for a doctor? To quote Gillie Bolton “Literature deepens the awareness of issues and experiences one cannot or will never have, and opens up different ways of perceiving the world. It offers first rate material for ethical study. An understanding of narrative can help clinicians develop On seeing this magazine, some of you may well be a clearer and more constructive relationship with the thinking, “Northwing? What on earth is Northwing?” everyday complex stories of medical situations.” given that it has been out of circulation for a bit longer than usual. Well, we’re back, for better or worse. In any case those papers for MTAS points don’t write However we must say the enthusiastic response we themselves. So get some practise in, please write for were expecting when we called for articles and Northwing! Let’s make it first class again. features was somewhat disappointing. With over 1000 students in the medical school and many more junior We really hope you enjoy reading this issue. doctors and faculty members, the list of contributors seems miniscule and unrepresentative as a whole. So Rachna Malani and Emily Thomas

CO - EDITORS-IN-CHIEF EMILY THOMAS, RACHNA MALANI

DEPUTY EDITOR SABREEN ALI

CONTRIBUTORS • Jenny Christie • Rory Mackinnon • Elishba Chacko • Helen Prescott • Ian Tapply • Dr Raj Joshi • Alex Dipper • Matthew Ranger • Dr Zoe Wyrko • Dr Dave Elphick • Dr Zubair Qureshi • Roddy McDermid • MEaL Society

• Peer Teaching Society • Register and be a Life Saver Society • Richa Gupta • Rachna Malani • Emily Thomas • Sabreen Ali

ADVERTISING RICHA GUPTA

TREASURER STEPHANIE FAULDING

PHOTO EDITOR MIKE COOPER

Northwing is the magazine of Sheffield University Medical School, produced with the support of the Sheffield University Medical Society. It is distributed free of charge to Medical students and Doctors (circulation 1200). For information about any advertising rates or to reserve a copy, please contact us at the address below. The views expressed in this magazine do not necessarily reflect those of the Northwing team of the Sheffield University Medical Society. Likewise, companies advertising in this magazine are not endorsed by Northwing and we accept no liability. We would like to thank those who have offered encouragement and help, especially the porters and Susan in the MedSoc Office. Special thanks to the University Print Service and the Medical Society for their support.

We very much welcome all your contributions!

E-mail us at: northwing@medsoc.net

Northwing The Medical Society Office, Sheffield Medical School, Beech Hill Road Sheffield, S10 2RX www.medsoc.net/northwing

May 2010

CONTENTS Page 5

MEDSOC News

Medical School News and General News

75th Anniversary Special

The ramblings of a final year...

Everyday Discrimination?

Medicine and People: A Point of View

Society Spotlight: Medical Ethics and Law

Do you own your body? Should you?

Medics Arts Corner

Wilderness Medicine: An interview with Raj Joshi

An African Adventure

Ill in KL

Medical Jokes

Northwing Crossword

Specialty Fortune Teller

Accommodation Review

Appt for Medics

The Peer Teaching Society

Being a GP: What does it take?

Book Reviews

A Note from the President... Condensing an amazing year into one page is not medics’ basketball has won the proud title of NAMS an easy thing to do! But here goes... basketball champions – congratulations! 2009 saw the creation of several new sports teams for Sheffield medics, with bouldering and running joining the ranks of our established teams. Our nonsporting activities continue to grow and our established societies continue to attract new members and are as successful as ever, showing that Sheffield is able to cater for, and offer, whatever our students feel that they need, both on and off the pitch. Academically, MedSoc continues to represent its members, and non-members, on most medical school committees. We remain actively involved in helping shape our curriculum and admissions process and are currently involved in the promotion of the National Student Survey to our finalists.

! As a society, we have had our most successful year in terms of recruitment. Over 220 freshers joined in September; increasing our membership to over 1300 medics and maintaining our status as the UK’s leading University Medical Society. Socially we have continued to set ourselves apart by attracting record numbers to our annual pub crawl. You drank MedSoc dry to the tune of £1100, you got foamy in Walkabout and you partied with Hallam before braving the fake snow in Crystal at Christmas! ! Thanks to the introduction of a non-alcohol policy to some of our socials, we are now also able to provide for even more of our members.

After 3 years on the MedSoc committee, it is a privilege to be elected as President. I take it as my responsibility to ensure that MedSoc makes your time at University as enjoyable as possible and that you are fully informed and supported for exams, OSCE’s, MTAS and anything else that life as a medic throws in your way.

Our annual charity, Weston Park Hospital, is now £6000 better off thanks to the fundraising effort of Sheffield medics – thanks to all who helped out! This evident enthusiasm, from all years as well as the new Phase 1a, was seen again in our recent elections with a staggering 572 students voting for the new 2010 committee. Over the past few years, MedSoc has worked hard to ensure value-formoney for its members. This year, with the introduction of Sheffield Student Spleens, your MedSoc cards will entitle you to discounts not open I would like to take this opportunity to thank Rav to other University students. These discounts are Jayasuriya who, as last year’s President, set the bar high for me to follow and who has helped turn set to increase in 2010. MedSoc around. Despite all the inevitable banter Activities-wise, Sheffield medics have once again that comes our way we remain the envy of other shown that they are not to be underestimated. Our faculties and societies – I intend to keep us batting rugby team have recently been promoted and above the rest and to build on our already great currently lie 3rd in both the Yorkshire Division 4 and reputation. the NAMS Northern Division League. Medics’ hockey remains hugely successful and they are set Roddy McDermid to host NAMS 2010 here in Sheffield. Finally, Medical Society President 2010/11

NEWS

NORTHWING 2009/2010

MEDSOC NEWS

NORTHWING 2009/2010

Medical School News Food for Thought...

“It’s Sheffield Medical School’s 182nd birthday! Yes the School of Medicine was founded in 1828. Well, happy birthday to the medical school! You don’t look a day over 100.” Well here’s something to reflect on - Patsy Stark has disappeared from Sheffield Medical School, leaving us with endless questions. Where has she gone? What is she going to be doing? Is she reflecting at home on her time here in Sheffield? What will we students do with all the time we have now that we needn’t reflect on every moment of our day? Alas she will be missed. Who will we mock now? I guess there’s always Prof. Bax and Mr. Chan. Oh but wait, rumors are circling that Prof. Bax may also be leaving the medical school. Could this be true? What will we do for entertainment? Back to Patsy. Taking over for her will be Michelle Marshall. Which once again leaves us with more questions. What will she be like? How will she change the curriculum?

Before we finish we have one more disappearance to note. As a student found out whilst telephoning the medical school, we have no dean. Yes that right, Sheffield medical school does not have a dean. Where did he go? Why did he leave? Will we get a new dean? Ah the list continues…

The original Sheffield Medical School in Surrey Street

Avatar, Alice in Wonderland and now...Atlas of Human Anatomy!

One advantage of this is that it uses real patient data and moves students away from idealistic text book anatomy: no two humans are the same.

3D technology has taken the big screen by storm and could soon become an integral part of medical school teaching. New technology as used in the film Avatar is being pioneered at the University of Aberdeen Medical School that enables an MRI scan to be converted into a 3D image.

The technology can also use other media such as video, and could be used to screen medical procedures providing a fully enhanced interactive experience.

It is not a new concept – 3D programmes used to study anatomy are already in use. However these outdated systems have to use handcrafted medical images or models which are costly, both financially and in terms of man hours. It can take weeks to create one image. On the other hand Dr Hamilton of the University of Aberdeen explains how the new software will be used. “We can take an existing medical scan, feed it into a computer and have a 3D stereoscopic image ready for teaching within a matter of seconds rather than weeks. “We could take a scan of a head injury, for example, input the scan into our system and create a virtual model of the head. This 3D image could then have parts of it, maybe the skin, ‘stripped away’ allowing the lecturer and student to fully explore the injury.” (Photographs from Google Images)

So, soon they’ll be selling tickets to MLT1. But don’t forget your 3D glasses!

Updates

“This painting by Alexander Beydeman was done in 1857, and depicts incarnations and historical figures of homeopathy observing the supposed brutality of medicine at the time”

Happiness as a cure? All those nights out. All those nights sitting with your friends making a meal and watching a movie. All the nights you popped down to the pub with your mates. Well my friends those were not wasted nights. No need to feel guilty about not revising or working on that SSC. Those nights, were saving you and saving the NHS. A study published on Feb. 27, 2010 done by group of researchers at Columbia University in New York discovered that being happy reduces your risk of developing cardiovascular disease. The group followed 1,739 adults over 10 years. They looked at symptoms such as depression and anxiety as well as positive symptoms such as joy, excitement and happiness. They found that patients who had a positive affect, even if it was small had a reduced risk of developing cardiovascular disease. Those who were unhappy had a 22% higher risk. Talk about primary prevention.

Group Overdoses

Shisha or cigarettes? The Department of Health, along with the Tobacco Control Collaborating Centre have found that smoking from a shisha pipe is just as harmful as smoking tobacco. The study has found that one session of shisha seriously increases levels of carbon monoxide in the blood, by at least 4-5 times higher as compared to cigarettes. Prolonged exposure to carbon monoxide can cause brain damage, cardiac toxicity and unconsciousness. Sometimes known as “herbal tobacco”, shisha is a popular method of social smoking in many Asian countries, including the Middle-East, India and Pakistan, and has since gained popularity in the West. Fruit-scented tobacco is burnt using coal, and is then passed through a container of water and inhaled through a long hose. This study is a breakthrough as many people consider shisha to be “not really smoking.”

No this isn’t an article about cults, well at least not really. As many of us have found, homeopathy is a topic that comes with much debate. Some consider it as a miracle cure, some consider it to be a commercialized, pseudoscience that is intent on conning susceptible people out of money, and some don’t care. Well at 10:23 am on Jan. 30th, 2010 groups of people all across the U.K. protested outside of Boots’ and downed homeopathic medicines in overdoses. Why? So that they could raise awareness of the fact that homeopathic medicines, in their opinion just don’t work. What was the result? Apparently the worst side effect of the overdose was a giant sugar rush.

NEWS

NORTHWING 2009/2010

News Bytes

1883

This section is dedicated to a brief selection Northwing articles through the ages. First formed in 1935 as the Sheffield medical school journal, it takes its name from the north wing of Firth Hall where the medics were based. Initially published three times a year and sold for a shilling it focused more on serious journal like articles submitted by both students and doctors. It even had a section for the dentists! Since then it has won the BMA award for best student magazine on several occasions and was even commended in The Times. There have been a few occasions when the future of the magazine has been uncertain, but it has always risen from the ashes to be part of this medical school and will hopefully continue for another 75 years. Happy 75th birthday Northwing!

1967

SPECIAL

May 2010

75 YEARS

1978

SPECIAL

1982

1990

SPECIAL

1985

SPECIAL The rest of this article can be found in the bowels of Western Bank Library - Stack number 3, Periodical number 610- by all means have a look if you have a burning desire to read on...Hopefully the archives will be online soon!

1980’s

1997

SPECIAL

1997

1988

FEATURES

NORTHWING 2009/2010

The ramblings of a final year...

It’s out of stock...

It’s the fifth year. Another placement finished, another proforma signed off. The usual rushed signature of a harassed consultant who doesn’t even know my name. I hand said form into medical school. Job done. But is it really?

The University of Sheffield is meant to be home to one of the best libraries in the U.K.—the information commons (IC). I still remember when the IC opened. It was shiny and colourful and had comfy sofas and a shower for some strange reason. Now even when it opened, it was a place for people to meet and socialise but it was also a place to work. If you walked in at 11 am on a Thursday you could find a place to sit AND a computer. Shocking, I know. Nowadays the IC is a nightmare. It’s full of 1st and 2nd years constantly pretending to work. Actually I take that back. They do some work—they sit and plan their social lives (that’s the bitterness speakingplacements have destroyed that for me). Oh yes shall we go to Space on Friday night and then Pop Tarts and Population (whatever that is).

Ignorance is bliss As students, all we really ever want, apart from long weekends and alcohol, is feedback. While on placement, yeah we like having teaching, patient contact is good too, but we want to know how we are doing. Like, actually. Not just a proforma signed off on the last day - usually the first time we are meeting our consultant, or a mini-CEX signed off by a poor harassed F1 who truly has NO time whatsoever to sit down and go through it. We need to know about our performance. For better or worse feedback will help us become better doctors, not just sitting on reflecting on the days events or on how you personally feel a history went. It helps enormously when someone, who knows what they are doing, actually sits and watches you do something and actually gives you some constructive criticism because when you do get their feedback, wait for it now, you can actually reflect on your performance. There it is medical school, the key to getting students to reflect.

Despite all the hours spent in there, these students seem to accomplish very minimal. I am not saying that I am a constant hard worker throughout the year (quite to the contrary - my revision is always last minute and based on panic and fear) but when I finally do get that urge to start work, I would like a place to do that. I can see those of you out there saying to me, well there are other places to work BESIDES the IC. Well then I would say to you, where?

NORTHWING 2009/2010

This time for revision I decided to do a little experiment. Throughout the months of March, April and May I split my time between the IC, HSL and St. George’s. I wandered aimlessly through each library and each time I ran into one or more of a few problems: a) Nowhere to sit b) No computer (probably a good thing come to think of it) c) No peace and quiet. Why will the two girls next to me not STOP talking? Not to sound cliché but no he’s probably not into you if he hasn’t called you in two weeks or why will the two lads in their kit next to me stop talking about the footie match and can you please shower because you still smell of sweat...and finally d) the last and final copy of medicine at a glance is gone - NOOOOOO! Now where will I get my knowledge from?? So as a desperate plea, please University of Sheffield, either create another library or at the very least extend opening hours of the Health Sciences Library.

So when you approach Mr. X you approach with an air of confidence, and you look at him and say, ‘Mr. X, I need to examine your heart.’ No, “is that okay and by the way I’m a medical student” just a selfassured I need to examine you. You poke and prod Mr. X and finally convince yourself that you have heard that murmur and you in turn leave Mr. X now in search of Mrs. Y who apparently has the most amazing fine inspiratory crackles and clubbing that you really don’t want to miss.

In the Jungle... You see your prey sitting, idly passing time. You wait, contemplating when would be the best time to pounce. You stand there stalking until you get the perfect opportunity to strike. There it is, the nurse has finally finished giving Mr. X his sponge bath. You edge towards him from behind the windows of the bay, mentally rehearsing your introduction and when you finally get there, it’s breakfast time. Which is then followed by the inevitable ward round, lunch, nap time and finally visiting hours. Mr. X has managed to escape you today but you will be back again tomorrow to try again.At times, and especially the closer OSCE’s get, patients become our prey. We hunt them for their signs. The closer exams approach the more you find it is the same patients getting harassed each time and each time we almost start to deceive them. We all walk around in the same smart clothes from the same shops (yes I’ve got that blue top from Dorothy Perkins as well) with our pens in our pockets and a stethoscope around our neck and sometimes a tendon hammer to hand and we can get away with looking like a doctor. So, like any predator who wants to get their prey we blend into the surroundings very well to get what we want. We know that Mr. X has aortic stenosis (everyone’s favourite ejection systolic murmur) but we also know that he has been examined by five of your friends and that the F1/SHO on the ward is circulating a list with his name on it to the hoards of medical students that keep popping up. (Photographs: From Google Images)

Is this how we have come to think of patients - as organ systems?

After finals, now with some time to think, you almost feel ashamed. These patients, and it usually is the same ones, have been examined so many times that by the end of it they know the examination better than you do! With the stress of exams looming it can be at times overwhelming and all you want is for Mr. Z to roll in the lateral decubitus position and take a deep breath out so you can listen to his mitral regurg instead of chat about his dog to you. It’s at times like that you have to remind yourself that Mr. Z is a human being, sitting in a hospital, where he probably does not want to be and he has a story to tell. That story may not be the most entertaining but it’s real and his and he wants to share it with you. So maybe next time, just before just asking Mr. A if you can feel his tender hepatomegaly and ascites, pull up a chair and have a nice chat with him if he wants. He may actually tell you something which could come in handy for the exams but at the very least he’s had an ear to listen to you and you’ve managed to escape the ward round for that bit longer!

Have something to get off your chest? Get in touch with Northwing - we want to hear your opinions!

By Dr Zoe Wyrko

FEATURES

NORTHWING 2009/2010

Everyday Discrimination?

Photo by Flickr: Matus Bence

Have you ever been a victim of age discrimination? Perhaps you’ve needed to rent a car or mini-bus, but been denied as vehicle rental companies state they do not insure those under a certain age; or tried to book a holiday away, but been told that groups of under a certain age are not accepted, unless there is also someone older staying?

and valuable member of society; older people have an equal right to effective and efficient health care services as those in younger age groups. The British Geriatrics Society (BGS) believes that decisions about health and social care should always be based around clinical appropriateness and not made on the basis of chronological age alone.

their complex needs. In practice, however, this is clearly not the case, and a survey of BGS members, carried out by Help the Aged, found that almost half of the respondents felt that the NHS is institutionally ageist, and that 72% of geriatricians said older people were less likely to be considered and referred on for essential treatments.

If the same question was asked of a group of over 65’s who have recently accessed NHS inpatient care, the answer would almost certainly be yes, however those affected may not realise it.

Ageing can however increase vulnerability to illness, and lead to a slower recovery once unwell, so it is unsurprising that the majority of hospital bed-days (currently around 60%) are consumed by elderly patients. This proportion is likely to rise further as the number of people aged over 65 years increases from the current 8.2 million to a projected 11.6 million by 2026. Given this information, it should follow that as older people constitute the majority of the health population, services should be directed to accommodate

Medical problems in the older person can often present as functional difficulties (commonly referred to as “off legs”) and lead to dismissal with the diagnosis of ` or social admission. This frequently leads to the person not receiving the assessment, diagnosis and subsequent management plan that they are entitled to, and thus being more likely to endure readmissions to hospital, or inappropriate placement in a rehabilitation or intermediate care facility when there are medical issues which need to be treated.

Old age itself is not an adequate explanation or cause of physical or mental illness, and many elderly people live independently in the community and need very little contact with medical services. Growing older is not a reason to no longer be considered as an important

It is also worth considering ageism in pharmaceutical research. Even though the majority of people taking medications are older, it is rare to see study candidates aged over 65 years, and even more unusual for those over eighty to be included, especially if they have

multiple co-morbidities and are taking concurrent medications. When this is related to the patients on a standard elderly care ward, with an average age of 89 years, it can be hard to see the relevance of the data. The older generation have traditionally been less vocal than their younger counterparts, either due to reticence in speaking out about inequalities, or an inability to in later stages of illness. This may, however, change in future years as the ‘Baby Boomer’ cohort are approaching pensionable age. In addition, a major aim of the 2009 Equality Bill is to address and make illegal discrimination on grounds of age in healthcare and social services. This legislation may help the further development of specialist elderly care services throughout all aspects of primary, secondary and tertiary healthcare; further encourage health promotion and screening; and provide motivation for greater education of all staff working with older people in terms of care and dignity. Geriatric medicine is a fascinating area to work in, and we are often considered to be the last of the true generalists. Problem solving is an essential part of everyday duties, and having to consider the social aspects as well as medical points of a person’s condition adds to the complexity. Team working with therapists and allied health professionals is essential. We look after our patients in a variety of settings, from acute and community hospitals to nursing homes and other care centres.

The British Geriatrics Society is a membership association of doctors, nurses, therapists, scientists and others with a particular interest and expertise in the care of the frail older person and in promoting better health in old age. It has an active Trainees Section, and is concerned with all levels of education, from the undergraduate curriculum to higher specialist training. Medical student grants are available to assist with elective projects, and other funding is available for research and to attend relevant conferences. Twice yearly scientific meetings are also held.

Photo by Flickr: Matus Bence

NORTHWING 2009/2010

Specialist elderly care wards, when supported by therapists and social work can lead to reduced length of stay and readmission rates when compared to general wards within the same hospital. Even when problems are not directly reversible much can be done, often by relatively simple methods such as equipment installation and medication review, to improve quality of life. A Comprehensive Geriatric Assessment is acknowledged as essential for any frail older adult admitted to hospital. The Giants of Geriatric Medicine are immobility, instability, incontinence and intellectual impairment; common conditions which cause considerable burden to older people but continue to be neglected in commissioning and service priorities. In addition, common conditions which affect all age groups are known to be less well managed in older people. In some cases, specific services can be harder for older people to access, for example thrombolysis in acute stroke is currently attracting large amounts of funding and publicity. However, the majority of people who suffer a stroke are older, which in itself is an exclusion criteria to thrombolytic therapy, and there is a risk of resources being directed away from slow-stream rehabilitation which can potentially help many more.

Written by: Dr Zoe Wyrko (zwyrko@tiscali.co.uk) Consultant, Geriatric Medicine, Selly Oak Hospital, Birmingham Honorary Deputy Secretary, British Geriatrics Society • • •

British Geriatrics Society: http://www.bgs.org.uk Oliver D. Age based discrimination in health and social care services. BMJ 2009;339:b3378. Age equality in health and social care. http:// www.dh.gov.uk/en/Publicationsandstatistics/ Publications/DH_107278

By Sabreen Ali

This change was not subtle - unlike, I believe, change in other aspects of medicine. How has caring for patients changed of late? Do they even matter in the end after all?

“Do the people really matter?” FEATURES

A past where the conventions of medicine were rarely questioned seems peculiar when compared to today’s practice. Evidence-based medicine has been steadily communicated into the health profession and has had a profound impact on all facets of the profession by challenging tradition and demanding proof of previously uncontested knowledge.

Photo by Flickr: Azli Jamil

NORTHWING 2009/2010

MEDICINE & PEOPLE A Point of View

may be, the concept is a good one. way, what is the point of such an Limitations such as lack of hygiene elaborate system? The System and access to medication, however, Overall it is largely accepted that the Being a patient is a somewhat ironic undermine the system. presence of the NHS is for the condition that most people experience but few actually want. Cost is another major determinant better, as for the most part it Ultimately it is not the idea of being of quality of healthcare. Since the provides efficient healthcare to those ill that troubles people – but the NHS came into effect in 1948, who need it. But is that the problem concept of opening themselves up to healthcare has been free for most of – has healthcare become too an indeter minate amount of the general public. While this system efficient? Has it lost all personal vulnerability as patients. Their lives is effective, some NHS trusts still connection with patients? Do the are in the hands of mere humans - come into huge deficits at the end of people really matter? capable of both accuracy and error, the business year – and this is The Doctor good and bad, right and wrong. becoming the trend as supply is Thus, making a patient feel at ease unable to meet demand. I was recently on a clinical by giving them ample support is one This latter fact also leads to lengthy attachment at a hospital, and there I of the principle responsibilities of w a i t i n g l i s t s f o r n o n - u r g e n t was able to gain perspective of the the health care system. procedures – a source of extreme doctor-patient relationship from the Accessibility of health care is nuisance to patients. Delayed sidelines, often a useful place to be certainly vital. In the UK, the undertaking of a procedure might to pick up nuances otherwise establishment of numerous GP lead to complications for the patient unnoticed. One of these was the surgeries within communities has while they wait. Even though attitude of some doctors towards meant better access to healthcare patients are assessed for the patients. To some doctors, a patient facilities. Internationally, however, likelihood of a complication, the was just like another file to be one of the biggest issues with health possibility of something going closed, a case to be solved. This was apparent from their behaviour with care is indeed limited accessibility – wrong does exist. patients and conversations with especially in the Third World. In Surgical procedures such as removal other staff. countries like India, China and s eve r a l i n A f r i c a , nu m e ro u s of cataracts have been known to be populations live without proper put on hold – classified as non- A scenario that surprised me was access to medical facilities or any u rg e n t b e c a u s e o f t h e s l ow when a doctor was on a morning progression of the disease. Having a ward round. Nurses shut the basic care at all. cataract remain in one’s eye may be curtains around one patient, in I am aware of villages in Northern a source of continuous pain and anticipation of the impending India where community-based care discomfort. If a patient’s well-being examination. is implemented. Rudimentary as it is going to be compromised in this

NORTHWING 2009/2010

The doctor, with a smirk in place, are exactly what the medical asked the nurse: “What’s wrong with profession is supposed to stand for – this one?” being genuinely interested in the patient and his/her concerns and The nurse giggled. being open and engaging. I believe that for a patient to be treated I was stunned when he referred to properly, it is not just a doctor’s the patient, no doubt sitting behind brainpower that matters, but the the curtain waiting anxiously, as strength of their heart too. “this one” – like he was talking about some inanimate object that The Patient needed fixing. The patient probably couldn’t help but overhear. The How do patients feel about their whole exchange was unprofessional care? Medical care is certainly and the blatant insensitivity appalled becoming more advanced with me. Patients are supposed to come technology on its side. Comfort and first, not just with regard to medical support levels are also going up. The attention, but also in terms of basic ward I visited for my attachment human understanding and courtesy. had individual consoles at every bed I suppose I must concede that which served as an entertainment doctors are human too, and are centre, with options of television, subject to moodiness and bad- movies and music. A phone was also temper. Nevertheless, a frequent attached, allowing patients to make uncaring attitude does not bode well and receive calls. I witnessed firstfor a doctor’s reputation - amongst hand how much the patients patients or colleagues. On the other appreciated this small console – it hand, there are some doctors who gave them the ability to take their

minds off their illnesses and to keep in touch with loved ones.

medics but welcomes participation from students in other courses to give a well rounded view of whatever topic is being discussed. There would also be a few talks by guest speakers which could serve as learning opportunities. A hot topic currently is euthanasia. Just recently news came out that the BBC reporter Ray Gosling admitted to carrying out a ‘mercy killing.’ Gosling decided to help end his lover’s life because he was dying of AIDS and was in “terrible, terrible” pain.

of choosing how to live. The second principle is grounded in the joint obligations to avoid doing harm and to do good – the principle that one ought to refrain from causing pain or suffering but act to relieve it instead.

Society Spotlight Medical Ethics and Law (MEaL) Most students tend to run in the opposite direction when the word ‘ethics’ is mentioned. This is probably due to the fact that it is a branch of medicine with a lot of grey areas. We have our hands full with learning about the innumerable diseases out there and their various treatments. We don’t want to be bothered with the potential minefield that is medical law and ethics. The maybes, shouldn’ts, why’s, what if ’s and therefore’s are enough to drive any sane medical student up the wall! Unfortunately, as doctors we may have to deal with these pesky little issues at some point in our careers and this is where MEaL comes in. We are a new society whose aim is to shed some light on controversial topics such as euthanasia, stem cell research and abortion to name a few. We will hold very informal meetings to discuss some of these issues which will give everyone a chance to air their opinions and views no matter what they are. MEaL is by no means exclusive to

The moral argument in favour of permitting euthanasia is based on two principles: Self determination ( a u t o n o my ) a n d m e rc y ( t h e avoidance of suffering). Self determination is the right to live one’s life as one sees fit, as long as this does not harm others. This could also be seen to include living the very end of one’s life as one chooses. Choosing how to die is part

Small things like this are what make a difference as to whether patients are comfortable in hospital or not. It shows them that we, in the health profession, genuinely care about every aspect of their well-being. At the end of the day, at least I think, that is our true duty. The Final Score As I have stated, there are different perspectives of patient care that we can use as viewpoints: the healthcare system, the doctors and the nurses, and the patients themselves. When the scores are tallied up, it seems that people really do matter to the professionals, at least for now. It appears that as more steel is being introduced into the medical field, the less warmth there is for the patients. Will this be alleviated or exacerbated? Only time will tell.

On the opposing side, there is the worry that euthanasia will not only be for people who are ‘terminally ill’. It could also become a means of health care cost containment. In regions where most of the healthcare is provided privately, doctors may find themselves far better off financially if a seriously ill or disabled ‘person’ chooses to die rather than receive long term care. Last but definitely not least of all is the opinion that euthanasia is a rejection of the importance and value of life. These are only a few points in the debate regarding assisted suicide. Undoubtedly, there are many more arguments to be heard and we hope that MEaL will be able to serve as a platform for all who are interested in participating in discussions about these crucial but fascinating issues. If you want to know more about the society, check out our facebook page!

An Essay by Matthew Ranger

The law has recently been confronted with cases in which the issue of how the body and its parts may be categorised has been determinative. This issue is likely to be encountered ever more often due to a constantly increasing capacity of biotechnologies to fragment bodies, enable tissue storage, and generate life through reprotechnologies, and also due to an increasing awareness of the commercial value of body parts to biomedical research. What the cases show is that the law is uncertain and unclear; indeed, this was emphasised by Gage J in AB and others v Leeds Teaching Hospital NHS Trust 2 . Although the traditional rule is often understood to be that the human body cannot be property, recent law appears to show that there are some respects in which it is and others in which it isn’t. Commentators such as Brownsword have argued that seeing the body as capable of ownership underpins recent law such as in the Human Tissue Act 2004; indeed, some commentators argue that a property regime for governing biological materials would protect individuals from exploitation. Other academics are not convinced, and a few have argued in response that regarding the body as property is demeaning to it. Currently, the law is not overly reluctant to find that separated body parts are capable of being property; hair, blood, and urine have all been held to be property and thus capable of theft. The courts’ recognition of limited property rights in cases dealing with corpses seems to indicate a slow shift in legal attitudes towards recognition of property rights; R v Kelly3 is a good example of this. Here, the Court of Appeal held that “parts of a corpse are capable of being property... if they have acquired different attributes by virtue of the application of skill, such as dissection or preservation techniques, for exhibition or teaching purposes.” Indeed, the Court went so far as to say that body parts could become property if they attracted “a use of significance beyond their mere existence”; an example given was an organ intended for use in a transplant operation. This line of thinking was developed4 in the recent case of Yearworth v North Bristol NHS Trust5, in which it was held that a sample of sperm being stored by a hospital in case a man became infertile was property; the rights of the owners to prevent the sperm from being used in certain ways and to destroy it were seen to be indicative of property rights. In another case, Dobson v. Northern Tyneside Health Authority6, it was

held that the deceased’s estate can claim lawful possession of a corpse (with a view to its burial or disposal) even though it cannot be owned; it was further held that property rights could arise in respect of body parts where some work or skill differentiated the body or its parts from a corpse in its natural state. Yet the law is no longer clear even on this; in Yearworth, it was stated that “a distinction between the capacity to own body parts or products which have, and which have not, been subject to the exercise of work or skill is not entirely logical.” It is hard to extract from these cases any coherent principles on which the courts are currently operating when determining whether bodies or body parts are property, and it is difficult to ascertain what type and degree of skill need to be exercised on a body part in order to give it a proprietary status. As Brazier has noted, the distinctions made are somewhat fanciful, and lack serious legal justification: “[p]ut to the uses of medicine... body parts become, as if by magic, property, but property owned by persons unknown, for purposes unforeseen by the deceased. If that represents the law, the law is an ass.”2 While it appears that, legally, we do not own our bodies, it is clear that certain parts or excretions of our bodies are capable of being owned; the case law indicates that the answer to the first part of the question has to be “no”, albeit a qualified one; this qualification is somewhat unclear. Justifications for an approach that doesn’t recognise ownership of the body often focus on human respect and dignity. Under these theories, seeing the body as property is demeaning and degrading; it embodies similar ideas to slavery. The law shouldn’t see the relationship that we have with our bodies as being the same as our relationships with, for example, our furniture items. Rao has gone so far as to argue that our relationship with our bodies is not one of “having” but one of “existing”; our bodies are the medium through which we interact with the world.3 These values are better protected through privacy rights than property ones. However, such views can appear too high-minded and out of touch. The case of Moore v Regents of the University of California4 helps to demonstrate this. Here, Moore had his spleen removed, and his doctor discovered that cells from it contained beneficial properties, and so he, without Moore’s knowledge or consent, developed a cell line which he sold for $15 million; the products produced as a result were worth several billion. The Californian Supreme Court held

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Do you own your body? Should you?

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that he didn’t have proprietary rights in his own cells; a main thread of its reasoning was that recognising so would set a precedent that would inhibit medical research. What Moore shows is that the dignity-based arguments are too idealistic, and they can even work both ways; here, a theory that centres on affording appropriate respect to bodies could just as easily be used to justify finding a property right; why should the researchers make all of the gains from the body parts and not the people from whom they were taken? If a property right is able to protect the person’s interest in dignity better than other rights, then there is a convincing argument for its adoption. Indeed, this is particularly relevant with damages and remedies, for a finding of violation of, for example, a right to dignified treatment is unlikely to give a remedy as comprehensive as the recovery of property or damages for its loss. One could even go so far as to argue that anything less than a property right is itself an insult to the special status of the body; property is afforded special protection in law, and so a system that doesn’t give equivalent or better protection to body parts is imperfect. To protect body parts as well as property is protected would require the people from whom the body parts came to be given rights over removed material and claims to profits created through the use of it. Additionally, the above arguments about property assume that the concept is far narrower than it actually is. Not all relationships with property are impersonal and lacking in any value beyond a material one; for example, pets are owned, but, to their owners, they carry far more value than their material wealth.2 Something’s being an item of property does not automatically mean that we should view it as only having value that attached to its status as an item of property; in can be valuable in many other significant ways. Moreover, recognising ownership of body doesn’t overly focus on preventing things’ being done to bodies, and it allows for the recovery of property from third parties, which a respect to body approach probably wouldn’t. Another common criticism of the idea of the body’s being property that is often raised is that it doesn’t fit within any recognised category of property, and its properties are so different that it can’t even form its own category of property. However, it can be argued that recognising ownership of the body best explains current thinking in the law. Brownsword and Beyleveld helpfully distinguish between rights relating to the taking of body parts (Rights A) and rights relating to the use and control of body parts (Rights B).3 It is obvious that the

law often protects Rights A, but we can find examples of the protection of Rights B in law such as the Human Tissue Act. Under this, we have control4 over the postremoval use of our body parts; we have the right to set the initial bounds of permitted use as well as the right to sanction deviations from the initial permitted use. Rights B seem to be very much like property rights; indeed, they seem far more like property rights than a regime to avoid religious or related harm, for the focus of the consent is on the use intended rather than any uses prohibited. To insist upon a consent requirement is to accept that people have protected interests in the uses to which their body parts are put; this privileged relationship between person and body seems to reflect an account of property rights. Moreover, as Brownsword and Beyleveld emphasise, one of the strongest conceptions of ownership is that we have “rule preclusionary” control of the property: we have prima facie rights to use the property how we wish to, and we don’t have to provide any justification to use the property in the way we wish to; this “implies that the relation in which X stands to the owner of X... is such that the owner’s control of X is so important to the owner’s legitimate interests that, as a rule, it is to be presumed... that the owner does not need to justify the owner’s control of X in any particular case.” To extend the point, if I cannot claim rule-preclusionary rights over my living body and its parts, then I cannot own anything in this sense, for the body is the strongest candidate for something that is so important to my legitimate interests that I should be given prima facie rights to do what I want with it without specific justification.2 A criticism of adopting this theory of the body and property could be that it wouldn’t allow scope for argument that the law should prevent certain uses of the body that it wouldn’t prevent with other property items; additionally, it doesn’t explain the current exceptions in the law, for example those created by the HTAct that allow the consent requirement to be overridden in certain cases; using tissue of an alive human for educational purposes is an example. However, the arguments in the above paragraph imply that, when the interest that others have in using property X against the owner’s will is of greater importance for the protection of the others’ rights than is the interest that everyone has in the rights of control granted by their property, the rights of control can be overridden. This can be used to justify exceptions to property rules that the law needs to create, as it can be seen to have done in the HTAct. Furthermore, we need to recognise that some property can be subject to

Finally, and I would suggest significantly, seeing the body as property would help us to avoid future difficulties in medical law. Consider the following example. It’s the year 2300, and artificial lungs that are biologically the same as real human lungs can be created for transplants. They are created using a process that doesn’t involve the use of anyone’s cells (so no original ownership issues arise), and they are compatible with all people. A company produces them and sells them to hospitals in the same way that various treatments are sold to hospitals today; thus, they are property and capable of ownership. A man needs a left lung transplant, and so it is replaced with an artificial one. The operation is done perfectly, and, in a year’s time, each lung is functioning as well as the other. If the law in 2300 is the same as it is today, we have encountered a bizarre legal result: his right lung is owned, while his left lung isn’t. Even though there is, in this case, no (or a negligible) distinction between the lungs in terms of biology, even though they sit side by side in his body, and even though the body relies on them both equally, they enjoy different legal statuses. It is hard to see why this should be, and so it is suggested that, for future legal coherence, ownership of the body should be recognised. An alternative approach to this problem would be that, in such cases, we cease to recognise the artificial lung as being subject to property law, but this would be far more inconsistent with any legal thinking than accepting that it is possible to own your body. In order to avoid such future difficulties, the law needs to modernise; in all likelihood, the future of medicine will mean that a high-minded view of the

All in all, the law of today regarding ownership of body is muddled, and it is nearly impossible to extract any reasoned principles underpinning the current law. Currently, we cannot say that we legally own our bodies, but the law indicates that we can own certain (removed) parts of our bodies. A property approach would provide a coherent framework for the law; indeed, it can be demonstrated that the current thinking behind the law sees rule preclusionary control of the body parts as being key. Moreover, the main arguments against allowing bodies to be property seem to place too much weight on the connotations of the label “property”, ignoring that strong value can be attached to property, as is the case with animals. Additionally, probable future medical developments suggest that it will be necessary to recognise ownership of the body, particularly as the distinction between what is classified as the body and what is not becomes ever finer.

“You be the judge...”

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sanctity of the body is untenable. Outside of medicine, we are already seeing social change, and the body is becoming ever more commercialised. Those blessed with good DNA are able to insure their looks; a narrowminded bodily integrity approach would have to condemn such (now generally accepted) commercialisation of the body.2

Picture from Google Images

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specific, exceptional rules; for example, we are not allow to abuse animals, and certain antiques will be subject to various regulations. Similarly, this would address the concern as in Moore that giving a property right would inhibit medical research, for recognising such a right would not necessarily mean that all profit made would be able to be recovered by the owner; for example, a special scheme of remedies could be made; or the law could add exceptions to the right to property, as it has done in other areas; or the researchers should be encouraged to enter into contracts with the donors.2 Most commentators agree that the law in relation to body parts and body ownership is unclear and in need of reform; with bodies, we are dealing with things that people fundamentally need to exist; it would be better to develop the law regarding them through an established area of law than a new, unpredictable one (indeed, the notion of privacy rights is vague); this would give us legal certainty and would avoid the existence of two substantially overlapping but distinguished legal areas.

An Interview with Raj Joshi By Emily Thomas

How did you get into expedition medicine, it must be really difficult to do? Is there anything in particular you would advise getting into first? I became involved in expedition medicine through my own interest and passion in climbing. I started going on remote expeditions with a few close friends who are excellent climbers to do our own mountaineering. A company my friend worked for was looking for an expedition doctor on a trip he was leading in Nepal. Due to my own mountaineering experience I was asked to go officially as the medical officer whilst my friend led the trip. I haven’t looked back since! It can be difficult to get into. There are some expedition medicine courses available which can last up to a week and are indeed very valuable and worthwhile, but they show the student which areas you need to develop more experience in and learn about, rather than teach someone all they need to know about expedition medicine. Experience is the key. I would advise any budding expedition medic to develop their experience through their own trips first. Trips don’t have to be months long Himalayan expeditions but can be a day walk in North Wales or the Peaks. Developing your own experience allows you to draw on a wealth of knowledge which no textbook can teach you as many situations out in the field are unique and require a degree of improvisation. Did you always know that it was what you wanted to do?If you hadn’t been able to do it, what do you think you would be doing instead? I’ve always had an affinity with nature and the outdoors. At an early age I knew I would always be involved with the outdoors throughout my life. My parents played a significant part, as ever since I was in nappies I was frequently heading to North Wales with them. We used to camp often and as I grew older my friends and I would go exploring and create our own adventures around the mountains and forests. These were my first true expeditions and memories I will treasure forever. North Wales will always have a special place in my heart. If I hadn’t been able to do expedition medicine then I would most likely still have a strong involvement with the outdoors, such as going on my own expeditions which I

currently do anyway. Perhaps I would have been more involved in sports medicine although the beauty of expedition medicine is that it has elements of all specialties including sports medicine. What does a typical day for you involve? It is really hard for me to define a typical day. To give an example I’ll just look at the last week: Day 1: I was summiting Kilimanjaro with a small group of wealthy ladies involved in the film and theatre industry. Day 3: I was doing some office work whilst in Tanzania before flying home to the UK. Day 4: I was in a meeting for my company . establishing deals with gear manufacturers, sourcing equipment and medical supplies. Then, as I also work as a medical advisor of looked at client’s medical problems, revamped their medical kits and advised on medical policy. Day 5: I had a meeting with Ben Fogle’s agent in the morning. I then had a photoshoot in the afternoon. Day 6: I was sorting the medical kits for a school’s expedition company I work for. In the afternoon I had an interview with a reporter. Day 7: I flew to Los Angeles on a flight repatriation job. I flew over to retrieve a poorly British citizen to bring back safely from LA. What is the most important skill an expedition doctor needs? Several skills are important and vital for an expedition doctor as he or she needs to be all encompassing. If I was pushed to name one then I’d have to say improvisation. In the field there are significant limitations to what medical equipment you can have with you mainly due to weight, encumbrance and cost. There will be situations where you need to think and act quickly to utilise what is around you. Improvising also conveys that the person most likely has a degree of experience in order to have the ability to fashion something out of very little. You must have travelled all over the world, where has your favourite expedition been? And why? My favourite expedition hasn’t been anywhere very exotic. It was simply on an expedition in Nepal with three good mates. What I remember especially about this trip was the camaraderie between all of us. Not just between four of us but also the Nepali crew. The area we went to was less travelled and even more so since we purposefully decided to go during monsoon to make it more interesting for ourselves. This feeling of remoteness drew the best out of our team as we had to rely on one another and forged a strong bond between all of us. Not to mention the fact that we saw some of the best views in the Himalaya and a strange creature which the Sherpas still believe was the Yeti!

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Wilderness Medicine

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And the most challenging? Several expeditions have been challenging for a variety of reasons. For technical challenges the Alps have some fantastic climbing. The most challenging trip I have led has to be the Comic Relief climb on Kilimanjaro. This was because as well as leading the celebrity team of nine, I actually had a total team of thirty three under my charge. This included security guards, BBC film crews, Radio One, multivision platform teams, comic relief staff etc. Every party had their own agenda and I had to bring all this together on the mountain. This meant that rather than just concentrate on leading the team, I was involved in every aspect whether it be security, filming and so on. The most challenging expedition where I was the Medical Officer was a military expedition in the wilds of West Papua. There was the difficulty of casualty evacuation if someone fell seriously ill and this was logistically problematic due to the terrain and remoteness of the situation, so we had to be self sufficient. In addition, I dealt with numerous native tribes-people with ill health which was a challenge for a variety of reasons such as communication, their own health beliefs and their expectations of what I could offer them. Interestingly, when it was my turn to feel worse for wear, I was treated and cured by one of their shamans! How did you get onto the comic relief team?

wasn't just from the comic relief angle as I knew some charity reps from other major charities, who were advertising Kilimanjaro fundraising trips to especially coincide with the BBC Kilimanjaro programme and as one of them said to me "it better go well as we are relying on this". The whole adventure tourism industry had taken a beating due to the recession and following the successful climb it was good to see how things improved across the board. Even companies not involved with the climb were finding that enquiries for their own Kilimanjaro climb had increased by over a thousand percent! Any gossip from the comic relief camp? I'll be leading Denise Van Outen and Fearne Cotton later this year in South America and perhaps a few others not involved in the comic relief climb, although I know how fickle the industry can be and this could all change by then. There may also be something very big planned for the not so near future but you'll just have to watch this space in a couple of years! We have an electives section in the magazine, so out of interest where did you go on your elective? I went to the state of

Ohio in USA. I was learning about sports medicine which was an official specialty over there, unlike the UK at the same time. Sports medicine is now an official specialty in the UK with a structured training programme so it will be interesting to see how expedition medicine develops…. Do you think it’s a good idea if medical students try and do expedition medicine as part of their electives?

This can be a great idea, especially as I picked up my opportunities for emails on the Raj with the BBC Comic Relief Kilimanjaro team, students can and are way back from including Alesha Dixon, Ronan Keating, Chris Moyles, being opened up. It's a Afghanistan one Cheryl Cole and Fearne Cotton great time to be involved day and one with an area of medicine in it's relative infancy email simply said "we have an interesting proposition for and the future looks exciting. There are a few reasons why you". When I returned home I travelled down to London to expedition medicine can be a special experience as an meet the directors of the company face to face to find out elective. what this proposition was about. They revealed the details Expedition medicine relies heavily on clinical skills due to and mentioned that they would like me to lead this trip as the lack of investigations available in the field. Students they felt I was the best person for the job. It was a can hone their clinical skills which can then be transferred privilege to be asked. There were some interesting names into the hospital environment. Organisation and being up who originally were due to climb the mountain but to scratch with your personal admin are abilities couldn't for a variety of reasons. important. Trips can have health benefits although they can be physically and mentally demanding with other risks Was there a lot more pressure than usual to make involved. Then there is the valid reason that some sure all of the celebrities made it to the top with the expeditions can provide people with the most magical huge amount of sponsor money they had made? and once in a lifetime experience. There was more pressure than normal. The group raised nearly 3.5 million pounds from the climb alone to buy anti- What is the most important piece of advice you malarial nets for countries in East Africa, so there was would give to a medical student? much being counted on this expedition. The pressure You only live once!

Dr Dave Elphick shares his experiences... By Richa Gupta

“How many of us have been or have thought of going to Africa for our elective or for a year out? How many of us have actually considered working there after we graduate? Dr. David Elphick, Consultant Gastroenterologist shared with us his experiences of working in Africa for 18 months as a General Physician.” RG: So how did Africa happen? What made you want to go there? Dr.E: Well, I initially went there as an undergraduate to explore the unknown… to do something different. However when I went there I realised how much the place needed doctors and decided to return at some point. Arranging to work in Africa was extremely difficult, more difficult than arranging any other job I have done in the UK. I applied for jobs at various hospitals in Africa for well over a year. I tried to go to Namibia and also to South Africa with the help of VSO but neither worked out. I then finally saw a small advertisement in the BMJ for a job to work as a physician in Saint Francis’ Hospital in Zambia.

RG: What kind of diseases did you get to see there? Dr.E: The main illnesses were either conditions that we were used to from the UK (heart failure, diabetes, stroke, chest infections etc.) or tropical diseases that we were not used to. There was a lot of malaria and HIV related illnesses (including TB, diarrhoeal diseases and Kaposi’s sarcoma). There were also rarer tropical diseases such as sleeping sickness, rabies, cystercicosis (pork tape worm) and Burkitt’s lymphoma. We also saw a lot of malnutrition and animal attacks including snake RG: Tell us a bit about the hospital. and even hippo bites! Hippos are actually very Dr.E:St.Francis’Hospital (www.saintfrancishospital.net/) aggressive; much more dangerous than crocodiles. is a mission hospital run jointly by the Zambian government and the church. It is situated in a rural area RG: Was there good treatment available? in a small place called Katete in the eastern province. Dr.E: We had very good basic medical treatment for The local population consists mainly of subsistence most diseases. At the time we were there proper farmers who are very poor. It is a fairly big hospital with treatments for HIV were not available which was very 360 beds and serves about 200,000 people. However distressing for us. We could not do much other than the medical staff are very few, with only 4 junior treat intercurrent infections, give multi-vitamins and doctors and 6 consultants. When I worked there, we crushed charcoal to stop diarrhoea. Fortunately, this has had two physicians (myself and my wife), two surgeons, now changed because anti retro-viral treatment is now one gynaecologist and one paediatrician. It is a nurse much cheaper. training school. The very well trained nursing staff play TB is incredibly common there and I started over 600 a slightly different role in patient care compared with people on treatment. Patients with TB were admitted to nurses in the UK. They do all the junior doctor’s jobs hospital for a significant length of time just to ensure (such as cannulation, bloods) and give medication. that they took the medication. However, washing and feeding patients is left completely to the relatives. The patients always come to hospital with a relative, and if they don’t, it is a complete disaster. The place has no GPs, so that patients come directly to the hospital outpatients department, which is like A & E. The hospital has 2 medical wards (I looked after the male ward and my wife the female ward). We also ran the two TB wards and helped on the paediatrics ward. There are also two surgical and one obstetrics ward. The labour ward is extremely busy, with over 2000 deliveries a year.

RG: Were there any other medical facilities for people there? Dr.E:The nearest town to Katete is Chipata which is about 50 miles away. There is another government hospital there which is not as well funded by foreign aid. There are one or two private doctors in Chipata who are too expensive for the majority.

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An African Adventure

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RG: What was your typical day like there? Dr.E: A typical working day started at 8 am with a hospital meeting which was often an administrative or educational meeting. We would discuss cases. This was followed by a ward round. I did the medical and paediatric patients’ ward round. In the afternoon we would have an outpatient’s clinic. Some days we had specialised clinics such as TB or diabetes clinic in which we reviewed patients. We usually finished by 5 p.m., when we went to the ‘pub’ across the road with the other doctors and foreign medical students before going home.

and not realise what the rest of the world is like. This job opened my eyes. RG: Can you tell us about the best thing that happened there, and worst thing that happened there? Dr. E: Many good things happening there everyday: helping a patient recover from treatable disease, the kindness of individuals, trips to the game park. It’s difficult to pick the best. The worst thing that happened was when people I knew developed AIDS. There was a nurse who worked on the male medical ward who was diagnosed with HIV. It was extremely distressing to see someone about my age develop clear signs of HIV. RG: Would you ever like to go back to Africa? Dr.E: I would love to go back. However it is very difficult to take time out to go and work abroad after you become a consultant. It is easier to do it as a junior doctor. You may find that people discourage you to go and work in a developing country. You may be told it is difficult to do and even harder to come back, but you can do it! Countries like Zambia really need doctors to come and work in them. Even as an elective medical student you can help by working in the hospital (especially as you’ll pay a small fee say 5 pounds a day for accommodation and food) which provides the hospital with vital income. An elective in Africa is a tremendous experience. As a junior doctor there you will be given much more responsibility than in the UK.

RG: What were the on calls like? Dr.E: On calls were very busy! The medical rota had 3 doctors and the surgical rota 3 doctors. It was not RG: What are your future career plans? unusual to be woken up in the middle of the night to Dr. E: To be a good doctor here – and to return to see an unwell child. The commonest out of hours Africa one day!. problem was malaria in children. RAPID FIRE ROUND RG: What was Zambia like as a place? Were there things to do? Dr.E: There were great things to do! There is the South Luangwa game park, which is 80 miles by road, or 40 miles walk or cycle from the hospital. We often went there for a weekend trip on our bicycles with a local guide. We saw the complete Africa thereelephants, lions, giraffes. We cycled through the game park and on one occasion had an entire herd of elephants crossing the track in front of us! We went there more than 10 times during our stay in Zambia. The other great thing there is Lake Malawi, which is 80 miles from where we were. We had to take a bus to get there. RG: So how was the overall experience? How did it affect you as a person? Dr. E: The overall experience was fantastic! It was the best job I have ever done. I greatly cherish the time I spent in Zambia. Everyday something exciting would happen. It is very easy to grow up in the UK system

Coffee or tea? Starbucks or Coffee Revolution? Galaxy or Dairy Milk? Sheffield Wednesday or Sheffield United? White coats or no white coats? Colonoscopy or Gastroscopy? Medical Student or Student doctor? Hometown or Sheffield? NHS or Africa?

A perspective from abroad By Sabreen Ali

If there is one place that seamlessly blends cultures, races and beliefs – it has to be Malaysia. Its capital city is Kuala Lumpur (affectionately known as KL) - a cosmopolitan hub in South-East Asia that has not lost its sense of tradition. The three main races are Malay, Indian and Chinese, along with several other minorities - and this mix brings a vibrant fusion of varying characters, languages and customs. Photo by Flickr: makinasu

What a large portion of the country’s inhabitants have in common is, strangely, the combined acceptance and rejection of the healthcare system. While it stands that Government and private healthcare are utilized, their services are often taken with a pinch of salt.

The KL skyline by dusk - the Petronas twin towers are the tallest in the world

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“Ill in KL”

Traditionally, the younger folk of the developing nation are heavily influenced by the previous generation’s thoughts, beliefs and superstitions. Arguably this is changing significantly with time, but for the most part, there are intrinsic beliefs in different families and races – sometimes with plenty of crossover as well. Many of these beliefs and practices transcend into the sphere of health and healthcare. In my experience, family doctors are given a lot of importance. And by that I don’t mean your friendly neighbourhood GP, but a doctor in the family. Regardless if one is approaching a cardiologist for an ear infection, or something even more obtuse – the resulting opinion is given significant weight by family members, and they may not see the need to get a further consultation done. The widespread use of alternative medicine is another result of the fusion of so many cultures. Shops selling traditional Chinese medications, herbal remedies and a further array of unknown substances are found littered throughout the city, and these small businesses thrive. Ayurveda is also common, with many dedicated centres set up offering a range of services. Also popular is the use of a “bomoh”, or a medicine man, akin to the witch doctors of the African continent. Their primary role is that of healing, as well as having an extensive knowledge of local medicinal herbs.

Photo by Flickr: gdstone

An Ayurvedic Doctor

! Existing alongside these practices are medical establishments at the forefront of modern medicine. The brand new Prince Court Medical Centre is a leadingedge establishment that rivals any private hospital in a developed country. The Kuala Lumpur Sports Medical Centre has an excellent reputation both locally and overseas for their medical services and is also involved in breakthrough original research. It is exactly this relationship of old and new that makes Malaysia what it is. Receiving healthcare can be up to date, old-fashioned or a paradoxical blend of the two – but one thing is for sure - it makes for a truly fascinating experience.

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Medical Jokes

So if you’re ever bored in lectures or are tired of standing around the nurse’s station waiting for something to do, here are some jokes to keep you entertained… What do you call 2 orthopaedic surgeons reading an ECG.

Doctor: I have some bad news and some very bad news. Patient: Well, might as well give me the bad news first. Doctor: The lab called with your test results. They said you have 24 hours to live. Patient: 24 HOURS! That's terrible!! WHAT could be WORSE? What's the very bad news? Doctor: I've been trying to reach you since yesterday.

A double blind trial.

How do you hide a £20 note from a General Surgeon? Hide it in the Patient's Notes.

A medical student is on the consultant ward round. Suddenly, after being ignored for the first 2 hours, the consultant turns to the medical student and asks him a question. The medical student realizes that he has completely no idea as to what the consultant is asking him. After a minute of silence the medical student finally answers the consultant: "If you have to ask me to get the answer to that question, you shouldn't be a doctor!"

A pipe burst in a doctor's house. He called a plumber. The plumber arrived, unpacked his tools, did some mysterious plumber-type things for a while, and handed the doctor a bill for 600 pounds. The doctor exclaimed "this is ridiculous, I don't even make this much money!" The plumber replied, "neither did I when I was a doctor".

A cop stopped a guy speeding on a motorway in carpool lane. He asked him, "Why are you on this lane, when you are driving alone?" The guy says, "I have multiple p e r s o n a l i t y disorder!!!"

Doctors were told to contribute to the construction of a new wing at the hospital. What did they do?

A Professor of Medicine, was (yet again) lecturing the medical students on the damage that alcohol can do. To demonstrate its effect on the nervous system, he took a worm and dropped it into a glass of gin & tonic. The worm wriggled around for a few minutes before finally giving a few convulsive twitches and dying. "And can we deduce anything from that?" asked the Professor with the triumphant air implying that only the obvious conclusion could be drawn. "Yes," came a voice from the back, "if you've got worms, drink alcohol."

The dermatologists preferred no rash moves. The gastroenterologists had a gut feeling about it. The neurologists thought the administration had a lot of nerve. The obstetricians stated they were laboring under a misconception. The ophthalmologists considered the idea shortsighted. The orthopods issued a joint resolution. The pathologists yelled, "over my dead body!" The paediatricians said, "grow up." The psychiatrists thought it was madness. The surgeons decided to wash their hands of the whole thing. The radiologists could see right through it. The GPs thought it was a hard pill to swallow. The plastic surgeons said, "this puts a whole new face on the matter." The podiatrists thought it was a big step forward. The urologists felt the scheme wouldn't hold water. The cardiologists didn't have the heart to say no.

NORTHWING 2009/2010

NORTHWING CROSSWORD NORTHWING CROSSWORD By Elishba Chacko

6 7

9 10

NORTHWING CROSSWORD 11

13 7

14 8

16 11

15 16 17

24 21

27 23

28 26

27 28 29

LIFESTYLE

30 30 31

32 32

Across:

Down: Down:

2. Chest pain due to ischaemia of heart muscle

1. Disease characterised by a facial “butterfly” rash (8,5)

3. Unnatural cell death

2. Condition leading to dysphagia

2. Chest pain due to ischaemia of heart muscle

1. Disease characterised by a facial “butterfly” rash (8,5)

3. Unnatural cell8.death Protrusion of stomach into thorax via diaphragm (6,6)

2. Tropical Condition leading dysphagia 4. parasitic diseaseto caused by T. cruzi (6,7)

Complication pregnancy 8. Protrusion of 11. stomach into ofthorax via diaphragm (6,6)

5. and parasitic ulcerative colitis are forms of this by disease 4. Crohn’s Tropical disease caused T. cruzi (6,7)

12. Functional bowel disorder

6. Internal bleeding

14. Non-caseating granulomas in lungs

7. Infectious liver disease transmitted via faecal-oral route (7,1)

11. Complication of pregnancy

5. Crohn’s and ulcerative colitis are forms of this disease

12. Functional bowel disorder 15. Benign tumour of fatty tissue

6. Severe Internal 9. lung bleeding disease causing acute lung inflammation (acronym)

Colic, ease aside 14. Non-caseating17.granulomas in (anagram) lungs (7,7)

10. of pampiniform plexustransmitted via faecal-oral route (7,1) 7. Dilatation Infectious liver disease

15. Benign tumour of fatty tissue

22. Monitors electrical activity of heart

13. Produced by C cells of thyroid

23. Fixed flexion contracture of the hand

17. Colic, ease aside (anagram) (7,7) found in lower intestine (1,4) 26. Gram negative bacteria

14. Fainting

10.Class Dilatation of pampiniform plexus 16. of diseases caused by narrowing of airways (acronym)

9. Severe lung disease causing acute lung inflammation (acronym)

27. Drugs used foroftreatment 22. Monitors electrical activity heart of rheumatoid arthritis (acronym)

18. formingby partCofcells pelvicof diaphragm 13.Muscle Produced thyroid

28. Condition causing gigantism 23. Fixed flexion contracture of the hand

19. of elasticity of alveoli, as found in !-1-antitrypsin deficiency 14.Loss Fainting

29. Latin for ‘apron’

26. Gram negative bacteria found in lower intestine (1,4) 30. Cell involved in bone resorption

20. Abnormal curvature of the spine

16. Class of diseases caused by narrowing of airways (acronym)

21. Condition where uterine tissue is found elsewhere in the body

27. Drugs used for of rheumatoid arthritis (acronym) 31.treatment Breathing difficulty when lying flat

18.Inflammation Muscle forming part of pelvic diaphragm 24. of the cornea

32. Backpacker’s 28. Condition causing gigantismdiarrhoea

25. large volumes urine as found in 19.Passage Loss ofof elasticity of ofalveoli,

33. Most common herpes virus in humans (7,4,5)

29. Latin for ‘apron’

30. Cell involved in bone resorption 31. Breathing difficulty when lying flat

!-1-antitrypsin deficiency

26. Fluid filtering from circulatory system, e.g. pus

20. Abnormal curvature of the spine

3421. Condition where uterine tissue is found elsewhere in the body 24. Inflammation of the cornea

NORTHWING 2009/2010

Uncover the right specialty for you! By Rachna Malani

Instructions 1. Fold the cutout into quarters 2. Unfold the cutout 3. Fold the four corners towards the middle 4. Turn the cutout over 5. Fold the four corners toward the middle again 6. Fold in half 7. You should now have four flaps. Place your thumb and index finger under each flap, and force opposite sides together so that your thumbs and fingers meet in the middle. 8. You should now have your very own fortune teller!

Tourniquet

9 A+E

Stethoscope

Cardiologist

11 G.P.

Anaesthetist Psychiatrist Surgeon

2 Radiologist Paediatrician

Clinical Handbook

Light Torch

20 35

Which hospital takes the prize?

By Ian Tapply

none were in my room. My quick thinking enabled me to claim two of the three and more importantly enjoy saying, ‘Let there be light…’

Doncaster

Grimsby The Diana, Princess of Wales Hospital in Grimsby is the furthest placement you can have as a medical student in Sheffield. It is 69 miles away on a desolate part of the north Lincolnshire coastline. So there is no escaping it, you have to stay. The accommodation therefore becomes a large part of your life since there are only three places you can be; the hospital (which is not desirable), the arcades in Cleethorpes (good for fish and chips) and your flat. Each flat in Grimsby consists of four bedrooms, a kitchen, a toilet and a bathroom. The bedrooms are eerily similar to those of the old Ranmoor, except maybe a bit larger. The desks are, to put it politely, not at all practical, and the number of chairs in each room varied from zero to three. Needless to say I stole a couple from my friend who was lucky enough to find three chairs in his room, including the world’s most comfortable armchair. The rooms are warm and the beds were comfy, to the extent that leaving them in the morning was a challenge. Even the sink worked, although it would be a braver man than I who would drink the water from it. The kitchen was similar: dated yet very much liveable. It possessed a microwave, fridge-freezer and the oldest cooker I have ever come across. This worked fine, although it took a little while to figure out. I assume the instruction manual has long been lost. There were a limited number of pots and pans, as well cutlery and crockery, the latter helpfully marked ‘property of the NHS, 1978’. My issue in Grimsby was with the bathroom, and in particular the shower. The lack of power I could live with, the temperature settings I could not. There were two, as my flatmate succinctly, if not politically correctly, put it: ‘burn the infidel’ or ‘freeze your b*****ks off’. There was also a third setting which seemed to alternate periodically between the two. None of these were useful. On the one occasion we found a bearable temperature, we left the shower on for two days just so we wouldn’t lose the tepid bliss. We concluded that leaving the shower on over the weekend would have been taking this a bit too far. The accommodation in Grimsby is not modern, but is very much an acceptable place to live. The main negative points were the shower, the lack of a TV, and the lack of internet access (24 hour access to the library was available). Finally my top tip for Grimsby is to scavenge any working light bulbs as soon as you get there. There were three left working in our flat when I arrived, of which

Despite Doncaster being very much a commutable distance away, the accommodation for medical students has been recently refurbished and so has a reasonably modern feel about it. There are about thirty rooms located along one corridor on the top floor of the accommodation block, which is located next to the Women’s Hospital of DRI. On the corridor there are also two kitchens, several bathrooms and toilets, and a TV room. Each room has a desk, wardrobe, sink and of course a bed. The sinks work in most rooms, but sadly for me did not work in mine. Actually that it is not entirely true, the cold tap never worked during my stay but the hot tap did to begin with. However a couple of weeks into my stay the top of the hot tap came off, spraying water everywhere in what can only be described as a cartoon-like manner. I did manage to fix it, in the end. Apart from that the room was really rather good, and felt like the medical student accommodation Travelodge would design. The kitchens are well equipped and like the bedrooms are modern, as is the TV room. The bathrooms are not so new but do have the luxury of showers which actually work. Doncaster even has a badminton court and a squash court on site which cost only £4 for a six week membership. This is even cheaper than it sounds since only one person has to become a member for you to be able to play. Finally there is also a computer room with internet access, even if only one of the computers works. The one slight drawback, or possibly advantage if you have poor circulation, is that the accommodation block is constantly heated to the temperature of a sauna. This did make sleeping difficult some of the time, and ensured any fruit you may have had in your room did not stay edible for long. All in all though, the rooms at DRI are about as good as one can hope for as a medical student. It’s just a shame they are so close to Sheffield.

LIFESTYLE

NORTHWING 2009/2010

Accommodation Review

NORTHWING 2009/2010

APPT for Medics By Rory Mackinnon

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NORTHWING 2099/2010

Register and be a life saver! By Helen Prescott What is R&B? R&B is a new society at Sheffield Medical School that trains volunteers to go into schools and talk about the importance of blood, bone marrow and organ donation to 15-18 year olds. The idea is not to get them to sign up to be donors, rather to give them the facts so they can make an informed decision in the future. A similar scheme is run in Germany where there is a much greater percentage of the population who are donors. History of R&B The Register and Be a life saver project was set up following the high profile campaign of Adrian Sudbury, a leukaemia patient from Sheffield. Adrian’s wish was for all young people to have the opportunity to learn more about donation. Despite a bone marrow transplant Adrian sadly lost his fight with leukaemia in August 2008. However, he always counted himself as one of the lucky ones after he was able to find a match for a bone marrow donor. This gave him an extra year of life. For many patients a match can never be found. Adrian was treated in RHH and there is now an isolation room on the haematology ward named after him. For the last 6 months of his life, when he knew that his leukaemia had returned, Adrian campaigned tirelessly to try and get the Government to back his campaign. He made numerous television appearances on local, national and international news. As well as having meetings with Gordon Brown himself! In July 2008 he handed a 10,000 strong petition to Downing Street. Last year pilot “Register and Be a life saver” projects were set up in Bristol and Sheffield by the Anthony Nolan Trust (The Anthony Nolan Trust is the charity responsible for running the UK’s largest bone marrow register.) In these areas volunteers were trained and were able to go into schools for the first time. A small group of medical students from Sheffield signed up to be trained as volunteers after meeting Adrian through the student society “Sheffield Marrow”. Sheffield Marrow is responsible for organising all of the bone marrow sign up sessions at Sheffield University therefore giving students the opportunity to register as bone marrow donors. Thanks to the huge success of the pilot projects, the R&B initiative has just received Government funding for the next two years and is now being rolled out on a national basis. Medical student Helen Prescott was at the House of Commons on December 8th 2009 with other R&B volunteers to hear the announcement which means that the project can now become bigger and better!

! Fast Facts - In the UK today there are 8000 people waiting for an organ transplant. When you go to bed tonight, 3 will have died just waiting for an organ - 7000 units of blood are needed everyday in our UK hospitals - There is currently just a 1 in 30 000 chance of finding a suitable donor from a bone marrow register. To improve this statistic more donors are needed. Success for Sheffield R&B so far - Over 60 Sheffield medical students have signed up as volunteers to deliver talks in schools - Talks already delivered at Sheffield High School and HindeHouse School - New committee elected in February '10 Want to help spread the word? Becoming a volunteer would involve attending R&B training evenings where you can learn a bit more about the different types of donation and get useful tips for how to present in schools. Each volunteer has access to an R&B PowerPoint presentation which they can adapt to make their own before signing up to deliver talks in local schools, usually in pairs or groups. E-mail Sheffield R&B at: sheffieldsaveslives@googlemail.com

The R&B group at Sheffield Medical School is the first R&B student society. If successful, it is hoped that students at other UK medical schools may follow suit. After all, medics are ideally placed to get the message across about the importance of donation. They can see first hand the benefit that patients get from blood, bone marrow and organ donation and also the huge demand that there is for more donors.

“To enable to students to develop their teaching skills...” • The society aims to provide some centralised, organised, and free teaching sessions that are available to all students on the undergraduate medical programme. • Teaching sessions are run as small groups and as lectures. • Small groups are defined as 12 students or less; lectures as 60 students or less. • Tutees will be able to register for the teaching sessions online at www.medsoc.net. They will receive an automated confirmatory email. • The teaching sessions benefit tutors by enabling them to develop their teaching skills and by aiding them in relearning past material. • The teaching sessions benefit tutees by enabling them to have interactive small group sessions with the ability to ask questions in friendly, non-threatening, surroundings and this can aid in the learning of new material. • Sessions are based on the core-clinical problems found on www.minerva.shef.ac.uk, they are not discipline specific (i.e. solely anatomy, physiology, pathology etc). For example with pre-clinical sessions they will involve pathology, physiology, anatomy, and histology combined for a given topic. This is similar for clinical sessions, which involve basic science, clinical features, treatment, and management options for a given topic.

Concessions: • All resources are made available on www.medsoc.net for those students unable to attend the sessions. • Currently we are only able to teach approximately 150 students per week (spread across 2 or 3 phases) at any one time. What the society does not provide:

• All sessions for a phase are organised by a phase co-ordinator.

• Revision sessions.

• All sessions up to, and including, phase 3a will be run by students.

• An alternative curriculum.

• All resources should have aims, objectives, and references. • The Student Gateway to medical education course allows participants who wish to further their understanding of medical education to develop knowledge around teaching and curriculum planning. • The society also runs the Peer Education Program (PEP) for the first years on ICE. Each tutor should deliver 4 sessions on a 1:1 or 2:1 basis. This broadens the numbers of tutors and tutees who can participate annually in peer teaching.

• Sessions by clinical, non-student, personnel up to and including phase 3a. • Teaching on topics outside those listed in the medical school curriculum.

SOCIETIES

NORTHWING 2009/2010

The Peer Teaching Society

NORTHWING 2009/2010

Being a GP

What does it take? By Jenny Christie Name: Dr Zubair Qureshi Graduated: Nottingham, 1997 Occupation: GP partner Previous jobs: F1/F2 in Mansfield, GP training in Lincoln

days. If you get anxious and worry a lot then the work will be more and more stressful. You need to be conscientious, well organised, hardworking and have good communication skills.

What’s it like being a GP?

What sort of patients do you see?

I really enjoy what I do. It can be hard work but you feel like you can better people’s day to day lives and influence families. There are a lot of targets and guidelines though, which can be difficult to meet. What are the best bits? You get to know your patients really well and you see families growing older. You also have a chance to get involved in other work as well. I am part of the University Primary Care research team and also work in the local commissioning group where we try and improve health services for the local community. And the worst bits? 1. Systemic lupus 2. Achalasia 4. Chagas disease 5. IBD 6. Haematoma 7. Hepatitis A 9. ARDS 10. Varicocele 13. Calcitonin 14. Syncope 16. COPD 18. Levator ani 19. Emphysema 20. Kyphoscoliosis 21. Endometriosis 24. Keratitis 25. Polyuria 26. Exudate

General practice can be extremely demanding and stressful. Clinics are very busy and we have a lot of paperwork and targets to meet. You have to have a good work/life balance, which is easier said than done! General practice can be quite isolated at times because you are often on your own as a GP and have to make tough decisions regarding patient care whereas in hospital there are a lot more doctors around working as a team. I am a GP partner so I am also an employer and this can be a difficult role because you have responsibility for a lot of staff. What type of personality is suited to the job?

You get to see all kinds of patients; you never know who’s going to come through the door. In a surgery consisting of 15 patients you can see children, babies and the very elderly as well. Home visits though tend to be for the elderly housebound patients. How did you find medical school? I loved university. I was quite hardworking but I think I found a balance and got involved with different clubs and societies. Luckily I lived with 3 other medical students and we worked as a group to get through our exams which really helped. What does a typical day involve? I start surgery at 8.30am and clinic runs till 11am. Then it’s paperwork and home visits. Afternoon surgery runs from 3-5.30pm and I tend to get home at 6.30pm. What advice would you give to a medical student wanting to become a GP?

I would advise that he or she think carefully about what they would like to do as a doctor. If they enjoy working in the community, being a front line doctor, working with families and like preventative medicine then they would probably I think it helps to be quite easygoing and relaxed. Each day enjoy general practice. Its definitely hard work but very can be quite different and there are easy days and hard fulfilling and satisfying.

Down:

Northwing Crossword Solutions 1. Systemic lupus 2. Achalasia 4. Chagas disease 5. IBD 6. Haematoma 7. Hepatitis A 9. ARDS 10. Varicocele 13. Calcitonin 14. Syncope 16. COPD 18. Levator ani 19. Emphysema 20. Kyphoscoliosis 21. Endometriosis 24. Keratitis 25. Polyuria 26. Exudate

Down:

2. Angina 3. Necrosis 8. Hiatus Hernia 11. Eclampsia 12. IBS 14. Sarcoidosis 15. Lipoma 17. Coeliac disease 22. ECG 23. Dupuytren 26. E-coli 27. DMARD 28. Acromegaly 29. Omentum 30. Osteoclast 31. Orthopnea 32. Giardiasis 33. Epstein Barr Virus

Across:

Northwing Cr 32. Giardiasis 33. Epstein Barr Virus

Foundations of Operative Surgery: An introduction to surgical techniques By Bruce Tulloh, David Lee Oxford University Press 2007, ISBN 9780199228669, RRP: £34.95 This surgical manual is perfect for trainees and medical students interested in a career in surgery. It covers both theory and practical skills, including common pitfalls and solutions. Chapters are concise and well illustrated, affording a very interesting read and providing a valuable aid to the acquisition of skills for trainees. Topics range from theatre etiquette and tying surgical knots, to the use of operating equipment and different surgery techniques. The last chapter skillfully combines all the fundamental manoeuvres illustrated in the previous sections and applies it to common operative procedures. In addition to the photographs and drawings there is a bonus dvd with video sequences that are highlighted in the chapters—this is especially useful as it reinforces learning of key surgical skills. Of course there is no real substitute for actually performing surgery but this compact manual provides the necessary bridge to develop good habits and implement them in practice. The Medical Student's Survival Guide: Early Years Bk. 1 By Elizabeth Cottrell ISBN 978-1846190865, RRP: £14.95 Aimed at first years this book is basically common sense in the written form and advice on a variety of topics, from getting loans, auditing, to social situations and cooking. There is even a recipe section in the back!! Overall, it’s a bit simplified, but the author is a recent doctor herself so her useful hints and tips are founded in personal experience. If you don’t know anyone in older years or have no medics in the family it’s a useful thing to read before leaving for university. The website links are also incredibly handy.Generally, an ok read with a few laughs, I particularly liked the section on “people you will meet at medical school”- some of the descriptions were very apt. However there can be no substitute for experience and living through medical school yourself and this guide isn’t going to live your life for you.

Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology By Jeremy Oats and Suzanne Abraham ISBN 978-0723433293, RRP: £38.99 What was the main thing that struck me on my Obstetrics and Gynaecology attachment? That a good knowledge of anatomy is rather important, and mine was sadly lacking. However, that was quickly remedied by this excellent text book. The main advantage of buying “Fundamentals of Obstetrics and Gynaecology” is definitely its great illustrations and clear, concise anatomical diagrams and the systematic manner it deals with the physiology, anatomy and pathology of this potentially daunting subject. However, some of the language is at times a little grandiose and it could be improved by using less complicated sentences to convey simple things. Overall though, I would highly recommend it.

EDUCATION & CAREERS

NORTHWING 2009/2010

BOOK REVIEWS

NORTHWING 2009/2010

Oxford Handbook of Clinical Medicine (8th Edition) By Murray Longmore, Ian Wilkinson, Edward Davidson, Alexander Foulkes and Ahmad Mafi Oxford University Press 2010, ISBN 9780199232178, RRP £24.95 This world-renowned text is nothing if not worthy of its reputation. A friend and guide to both medical students and junior doctors, this is a must-have to get through general medicine. Colour-coded chapters comprise of the different areas in medicine (e.g. cardiovascular, respiratory etc.), and each sub-topic is covered within a 2 page spread - which is one of the main attractions of this book. The style of writing is a definite plus - all the information is there but conveyed in a straightforward style which is easy to grasp and understand. In addition to medical sections, it also includes chapters on surgery, clinical chemistry, epidemiology and radiology. It is filled with clever mnemonics, as well anecdotes which speak to the person behind the personality. Frankly, if you don’t own a copy of this book, you don’t know what you’re missing. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors By Harold Ellis and Vishy Mahadevan Wiley-Blackwell, ISBN 9781405186179, RRP: £34.99 Ellis’ Clinical Anatomy book has a simple theme throughout – only the essentials. After going through the book, one realizes that Ellis has written this book in order to demonstrate what he feels is ‘essential’ anatomy with relation to its clinical significance. The book itself is very easy to understand and does not go into too much detail. On its own, the book is not enough to get one through the course. However, if supplemented with an anatomy book such as one by Snell or even just an anatomy atlas, the book serves as an excellent companion. The book is full of helpful colourful diagrams that demonstrate the anatomy very well and is easy to understand. Overall the book serves as an ideal revision guide.

Featured Review

“Direct Red - A Surgeon’s Story” By Alex Dipper

Published at the start of this year, Gabriel Weston offers an insight into the experiences of a surgeon, but what distinguishes her account from the reams of similar books already out there? Before embarking on her medical degree in London as a mature student, Weston first undertook a degree in English. Perhaps it was this experience which equipped her with a ‘down to earth’ approach, as this is a frankly

honest description of her journey from medical school to her current post as a part-time ENT surgeon. In ‘Direct Red’ Weston narrates the experiences which have shaped her most and her truthful writing engages the reader in what it is like to be a female surgeon in the twenty-first century. It is witty too, at times I found myself laughing out loud, often to the bemusement of others! Her compassion is undeniable and the stories of varied experiences on the wards and in theatre convey the age-old struggle with the professional necessity to remain detached. Although as medical students we have yet to fully face the expectations placed upon members of the medical profession, I found it easy to relate to Gabriel Weston’s experiences and the emotional struggles they bring, as she writes in such an accessible manner. I was struck by the similarity of her student experiences to those which we share today, most notably her recollection of the dissection room. Her description of the nervous intrigue which surrounded the first d i s s e c t i o n ex p e r i e n c e b ro u g h t memories flooding back and I found it interesting that the moments she

remembered and lessons she took from it were remarkably similar to those which I, and I am sure many others, will also remember in twenty years time. My only criticism of this book was that I felt much had been left unsaid. I felt it finished rather abruptly, with a couple of paragraphs detailing Weston’s decision to resign from a training post and become part time surgeon. After reading 180 pages about her career in surgery I wanted to know more about what had swayed this decision, rather than simply “I chose a life with more home in it.” Even if you do not see yourself as a budding surgeon, I would strongly urge you to read this book. There are lessons for all of us here, even if it is in simply realising that no matter how scared or powerless you may feel at times, many others have been there before you and survived! Through her various experiences it became evident that even the greatest doctors make mistakes which they will regret, but it is from these we learn. Importantly it was clear that it is possible to succeed in surgery and still be compassionate.

Student BMA News

student Page 4 Students decide: a preview of the BMA students conference

Medical school commits to providing free Wi-Fi access

The BMA supports thousands of students through medical school

EXCLUSIVE BY LISA SMYTH AND LISA PRITCHARD

every year. By providing learning and revision tools, as well as guidance on the latest ethical and professional issues, we start you on the road to becoming a qualified doctor. Membership includes:

MEDICAL STUDENTS are to benefit from free Wi-Fi while on clinical placements following a BMA campaign. The BMA Northern Ireland medical students committee and BMA Belfast intra-school committee had urged Belfast to introduce free Wi-Fi in order to make studying while away from university easier. Students had complained that their studies were being hampered by poor internet connections and a lack of textbooks, particularly when they were based in hospitals or on placements a long way from the main Belfast teaching hospitals and university facilities. The medical school has been providing increasing amounts of e-learning material, which students had been unable to access online. All third year learning materials, for example, are now online. Belfast has agreed to ensure Wi-Fi is available for medical students at all periphBMA BELFAST intra-school eral placements from 2011. committee chair Emma Students on placement at Hopkins (pictured) outlined Altnagelvin Area Hospital the challenges facing many should benefit sooner. of her peers studying on The move has been welplacements. comed by student leaders who Fourth year Ms Hopkins thanked the university for said: ‘While on placement addressing their concerns. it is very difficult to access BMA medical students the internet, which means committee Belfast representa- It should make a real differ- the BMA can achieve for I cannot check my email tive Luke Boyle said the move ence to everyone in peripheral our members.’ hospitals next year.’ or keep up to date with represented a great victory for A spokesperson for ! Student BMA members are the ever expanding all medical students. reminded they have full online content of Belfast’s He added: ‘I would like to Queen’s University Belfast to the BMA library access facilities, added that until the Wi-Fi medical course.’ pay tribute to university was which include a officomplete She cited concerns cials, in particular deputy fully installed, the university range of core medical about limited numbers of director of medical education would supply third years with text books. Extendedstudent borcomputers, safety when Kieran McGlade, for being copies of the online learning rowing facilities mean up to 20 walking to computer suites receptive to us and addressing materials on DVD. NIMSC chair Neil Cun- books and 12 DVDs at a time late at night, and library our concerns.’ can be borrowed for up opening hours. ISC chair Emma Hopkins ningham said: ‘It is an months and can then to three be posted She said many student added: ‘This was something excellent result for the hard back to London free of charge. work of the NIMSC and doctors were forced to that the ISC really wanted rely The library can also buy to ISC on behalf of medical the upon textbooks, but many address this year, and I’m stu- books on request. very Find out peripheral hospital libraries happy that the medical school dents. This result shows how more at www.bma.org.u k/library were not stocked or set has addressed it so quickly. accommodating the medical " View from … up Northern school can be, and what for undergraduate students. Ireland, page 6

Farewell to a digital desert

• Monthly Student BMA News and Student BMJ Student BMA News is a supplement of student BMJ April 2010

• Free loans and searches from BMA Library • Discounts on medical equipment • Guidance on planning your elective

LETTERS: ‘No one is born with all

• Elected representatives leading campaigns on your behalf on matters such as education, finance and welfare. Join now at www.bma.org.uk/join

BMA House Tavistock Square London WC1H 9JP Email studentbmanews@bma.org.uk

www.bma.org.uk/studentbmanews 44

www.bma.org.uk/studentb manews

Page 6 Time to reflect: the sobering effect of being a patient

Page 7 Open house: the case for wider access to medicine

Health secretary says no to pay proposals

THE BMA has condemned choosing to interfere with government interference the that pay review body’s recomwill see thousands of new juniors miss out on recom- mendations, has not fully taken into account the finanmended pay rises. cial pressures on junior Health secretary Andy Burnham stepped in to limit doctors in their first years of postgraduate training. increases recommende d by They have average the DDRB (Doctors and Dendebts of £22,000.’ tists Review Body) for new The government did agree doctors in England. that a banding multiplier BMA council chairman should be introduced Hamish Meldrum said for the association was disappointed FHO1 posts that only attract basic pay. with the decision. Junior posts are banded The DDRB wanted FHOs (foundation house officers) according to how frequently a doctor works in excess to receive a 1.5 per of cent 40 hours per week and how rise to ensure their pay unsocial the hours are. remained competitive in The banding forms a pay comparison with other supplement on top of basic professional groups. pay. The number of banded But Mr Burnham said the government did not accept posts has reduced over the years as shorter working there was a compelling case for the rise and FHOs would hours have been introduced, meaning more juniors receive a 1 per cent increase, in receiving only basic are line with specialty trainees. pay levels, particularly in The governments in Wales the foundation years. and Scotland have decided to The DDRB says it is award the full 1.5 per cent rise to FHOs — a move com- concerned about the implicamended by BMA junior tions of this for earnings doctors committee chair Shree and recruitment. It recommended that Datta. Northern Ireland is yet the banding multiplier to decide. for unbanded FHO1 posts Dr Meldrum said: ‘We are particularly disappointed attracting only basic pay should be set at 5 per cent that the government, of in basic salary.

PRESS EYE

— hitting the target

APRIL 2010

The voice of tomorro w’s doctors

BMA seeks dialogue with admissions test agency

MEDICAL STUDENT month’s Student BMA News, leaders are continuing to found that the UKCAT protest about the use and expense of the UKCAT favoured male, privately (United Kingdom Clinical educated applicants. In a written response to Aptitude Test). a letter from the MSC, UKCAT The BMA medical students committee has long Consortium chief operating argued that the test, which officer Rachel Greatrix says her organisation will be has to be paid for by applicarrying out research cants, acts as a barrier into to medicine for people from the effect of the test on lower socio-economic groups, widening participation. Last month the and says that the data MSC collected is used inconsistently decided to seek a faceto-face meeting by medical schools. with UKCAT officials to press A recent Nottingham Unifor further action. versity study, reported in last " Feature, page 7

the gifts required to be a

doctor’ Page 5