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Medical students and professionals sharing their thoughts and experiences.
50258c019b862b77cb3c92a0a2f8dbfe
2
47

Biohacking - The Brighter Side of Health

2014 is already more than a month old (if you can believe it) and with each passing day, the world we live in is speeding towards breakthroughs in every sphere of life. We're running full tilt, wanting to be bigger and better than we were the day or the hour before. Every passing day reinvents the 'cutting edge' of technology, including medical progress and advancement. Gone are the medieval days when doctors were considered all knowing deities, while medicine consisted of leeches being used to drain 'bad blood'. Nowadays, health isn't just about waiting around until you pick up an infection, then going to your local GP to get treated; in today's world it's all about sustaining your wellbeing. And for that, the new kid on the block is biohacking. Biohacking is the art and science of maximizing your biological potential. As a hacker aims to gain complete control of the system he's trying to infiltrate, be it social or technological; similarly a biohacker aims to obtain full control of his own biology. Simply put, a biohacker looks for techniques to improve himself and his way of life. Before you let your imagination run away with you and start thinking of genetic experiments gone wrong, let me assure you that a biohack is really just about any activity you can do to increase your capabilities or advance your wellbeing. Exercising daily can be a biohack. So can doing the crossword or solving math sums, if it raises your IQ by a few points or improves your general knowledge. What characterizes biohacking is the end goal and the consequent modification of activities to achieve that goal. So what kind of goals would a biohacker have? World domination? Not quite. Adding more productive hours to the day and more productivity to those hours? Check. Eliminating stress and it's causes from their lives? Check. Improving mood, memory and recall, and general happiness? You bet. So the question arises; aren't we all biohackers of sorts? After all, the above mentioned objectives are what everyone aspires to achieve in their lives at one point or the other. unfortunately for all the lazy people out there (including yours truly), biohacking involves being just a tad bit more pro active than just scribbling down a list of such goals as New Year resolutions! There are two main approaches to selecting a biohack that works for you- the biggest aim and the biggest gain. The biggest aim would be targeting those capabilities, an improvement in which would greatly benefit you. This could be as specific as improving your public speaking skills or as general as working upon your diet so you feel more fit and alert. In today's competitive, cut throat world, even the slightest edge can ensure that you reach the finish line first. The biggest gain would be to choose a technique that is low cost- in other words, one that is beneficial yet doesn't burn a hole through your pocket! It isn't possible to give a detailed description of all the methods pioneering biohackers have initiated, but here are some general areas that you can try to upgrade in your life: Hack your diet- They say you are what you eat. Your energy levels are related to what you eat, when you take your meals, the quantity you consume etc. your mood and mental wellbeing is greatly affected by your diet. I could go on and on, but this point is self expanatory. You need to hack your diet! Eat healthier and live longer. Hack your brain- Our minds are capable of incredible things when they're trained to function productively. Had this not been the case, you and I would still be sitting in our respective caves, shivering and waiting for someone to think long enough to discover fire. You don't have to be a neuroscientist to improve your mental performance-studies show that simply knowing you have the power to improve your intelligence is the first step to doing it. Hack your abilities- Your mindset often determines your capacity to rise to a challenge and your ability to achieve. For instance, if you're told that you can't achieve a certain goal because you're a woman, or because you're black or you're too fat or too short, well obviously you're bound to restrict yourself in a mental prison of your own shortcomings. But it's a brave new world so push yourself further. Try something new, be that tacking on an extra lap to your daily exercise routine or squeezing out the extra time to do some volunteer work. Your talents should keep growing right along with you. Hack your age- You might not be able to do much about those birthday candles that just keep adding up...but you can certainly hack how 'old' you feel. Instead of buying in on the notion that you decline as you grow older, look around you. Even simple things such as breathing and stamina building exercises can change the way you age. We have a responsibility to ourselves and to those around us to live our lives to the fullest. So maximise your potential, push against your boundaries, build the learning curve as you go along. After all, health isn't just the absence of disease but complete physical, mental and social wellbeing and biohacking seems to be Yellow Brick Road leading right to it!  
Huda Qadir
over 3 years ago
2257fe0ee21c3622a3e45cdaf279d4c3
9
91

Is ADHD a difficult diagnosis?

In a recent article in the BMJ the author wonders about the reasons beyond the rising trend diagnosing Attention Deficit Hyperactivity Disorder (ADHD). The article attempts to infer reasons for this. One possible reason was that the diagnostic criteria especially DSM may seem for some to be more inclusive than ICD-10. The speculation may explain the rise of the diagnosis where DSM is used officially or have an influence. In a rather constructive way, an alternative to rushing to diagnosis is offered and discussed in some details. The tentative deduction that the Diagnostic Statistical Manual (DSM) may be one of the causes of rising diagnosis, due to raising the cut-off of age, and widening the inclusion criteria, as opposed to International Classification of Diseases, 10th revision (ICD-10), captured my attention. On reading the ICD-10 diagnostic criteria for research (DCR) and DSM-5 diagnostic criteria, I found them quite similar in most aspects, even the phraseology that starts with 'Often' in many diagnostic criteria, they seem to differ a bit in age. In a way both classification, are attempting to describe the disorder, however, it sounds as if someone is trying to explain a person's behaviour to you, however, this is not a substitute to direct clinical learning, and observing the behaviour, as if the missing sentence is 'when you see the person, it will be clearer'. El-Islam agrees with the notion that DSM-5 seems to be a bit more inclusive than ICD-10. A colleague of mine who is a child psychiatrist and she is doing her MSc. thesis in ADHD told me, that DSM-5 seems to be a substantial improvement as compared to its predecessor. The criteria - to her - though apparently are more inclusive, they are more descriptive with many examples, and she infers that this will payback in the reliability of the diagnosis. She hopes gene research can yield in biological tests for implicated genes and neurotransmitters in ADHD e.g. DRD4, DAT, gene 5,6,11 etc. One child psychiatrist, regretted the fact that misdiagnosis and under-diagnoses, deprive the patient from one of the most effective treatments in psychiatry. It is hoped the nearest forthcoming diagnostic classification (ICD-11), will address the issue of the diagnosis from a different perspective, or else converge with DSM-5 to provide coherence and a generalised newer standard of practice. The grading of ADHD into mild, moderate, and severe seem to blur the border between disorder and non-disorder, however, this quasi-dimensional approach seems realistic, it does not translate yet directly in differences in treatment approaches as with the case of mild, moderate, severe, and severe depression with psychotic symptoms, or intellectual disability. The author states that one counter argument could be that child psychiatrists are better at diagnosing the disorder. I wonder if this is a reflection of a rising trend of a disorder. If ADHD is compared to catatonia, it is generally agreed that catatonia is less diagnosed now, may be the epidemiology of ADHD is not artefact, and that we may need to look beyond the diagnosis to learn for example from environmental factors. Another issue is that there seems to be significant epidemiological differences in the rates of diagnosis across cultures. This may give rise to whether ADHD can be classified as a culture-bound syndrome, or whether it is influenced by culture like anorexia nervosa, or it may be just because of the raising awareness to such disorders. Historically, it is difficult to attempt to pinpoint what would be the closest predecessor to ADHD. For schizophrenia and mania, older terms may have included insanity, for depression it was probably melancholia, there are other terms that still reside in contemporary culture e.g. hypochondriasis, hysteria, paranoia etc. Though, it would be too simplistic to believe that what is meant by these terms was exactly what ancient cultures meant by them, but, they are not too far. ADHD seems to lack such historical underpinning. Crichton described a disorder he refers to as 'mental restlessness'. Still who is most often credited with the first description of ADHD, in his 1902 address to the Royal College of Physicians. Still describes a number of patients with problems in self-regulation or, as he then termed it, 'moral control' (De Zeeuw et al, 2011). The costs and the risks related to over-diagnosis, ring a warning bell, to enhance scrutiny in the diagnosis, due to subsequent stigma, costs, and lowered societal expectations. They all seem to stem from the consequences of the methodology of diagnosis. The article touches in an important part in the psychiatric diagnosis, and classifications, which is the subjective nature of disorders. The enormous effort done in DSM-5 & ICD-10 reflect the best available evidence, but in order to eliminate the subjective nature of illness, a biological test seems to be the only definitive answer, to ADHD in particular and psychiatry in general. Given that ADHD is an illness and that it is a homogeneous thing; developments in gene studies would seem to hold the key to understanding our current status of diagnosis. The suggested approach for using psychosocial interventions and then administering treatment after making sure that it is a must, seems quite reasonable. El-Islam, agrees that in ADHD caution prior to giving treatment is a recommended course of action. Another consultant child psychiatrist mentioned that one hour might not be enough to reach a comfortable diagnosis of ADHD. It may take up to 90 minutes, to become confident in a clinical diagnosis, in addition to commonly used rating scales. Though on the other hand, families and carers may hypothetically raise the issue of time urgency due to scholastic pressure. In a discussion with Dr Hend Badawy, a colleague child psychiatrist; she stated the following with regards to her own experience, and her opinion about the article. The following is written with her consent. 'ADHD is a clinically based diagnosis that has three core symptoms, inattention, hyperactivity and impulsivity in - at least - two settings. The risk of over-diagnosis in ADHD is one of the potentially problematic, however, the risk of over-diagnosis is not confined to ADHD, it can be present in other psychiatric diagnoses, as they rely on subjective experience of the patient and doctor's interviewing skills. In ADHD in particular the risk of under-diagnosis is even more problematic. An undiagnosed child who has ADHD may suffer various complications as moral stigma of 'lack of conduct' due to impuslivity and hyperactivity, poor scholastic achievement, potential alienation, ostracization and even exclusion by peer due to perceived 'difference', consequent feelings of low self esteem and potential revengeful attitude on the side of the child. An end result, would be development of substance use disorders, or involvement in dissocial behaviours. The answer to the problem of over-diagnosis/under-diagnosis can be helped by an initial step of raising public awareness of people about ADHD, including campaigns to families, carers, teachers and general practitioners. These campaigns would help people identify children with possible ADHD. The only risk is that child psychiatrists may be met with children who their parents believe they might have the disorder while they do not. In a way, raising awareness can serve as a sensitive laboratory investigation. The next step is that the child psychiatrist should scrutinise children carefully. The risk of over-diagnosis can be limited via routine using of checklists, to make sure that the practice is standardised and that every child was diagnosed properly according to the diagnostic criteria. The use of proper scales as Strengths and Difficulties Questionnaire (SDQ) in its two forms (for parents SDQ-P and for teachers SDQ-T) which enables the assessor to learn about the behaviour of the child in two different settings. Conner's scale can help give better understanding of the magnitude of the problem. Though some people may voice criticism as they are mainly filled out by parents and teachers, they are the best tools available at hands. Training on diagnosis, regular auditing and restricting doctors to a standard practice of ensuring that the child and carer have been interviewed thoroughly can help minimise the risk of over-diagnosis. The issue does not stop by diagnosis, follow-up can give a clue whether the child is improving on the management plan or not. The effects and side effects of treatments as methylphenidate should be monitored regularly, including regular measurement height and weight, paying attention to nausea, poor appetite, and even the rare side effects which are usually missed. More restrictions and supervision on the medication may have an indirect effect on enhancing the diagnostic assessment. To summarise, the public advocacy does not increase the risk of over-diagnosis, as asking about suicidal ideas does not increase its risk. The awareness may help people learn more and empower them and will lead to more acceptance of the diagnosed child in the community. Even the potential risk of having more case loads for doctors to assess for ADHD may help give more exposure of cases, and reaching more meaningful epidemiological finding. From my experience, it is quite unlikely to have marked over-representation of children who the families suspect ADHD without sufficient evidence. ADHD remains a clinical diagnosis, and it is unlikely that it will be replaced by a biological marker or an imaging test in the near future. After all, even if there will be objective diagnostic tests, without clinical diagnostic interviewing their value will be doubtful. It is ironic that the two most effective treatments in psychiatry methylphenidate and Electroconvulsive Therapy (ECT) are the two most controversial treatments. May be because both were used prior to having a full understanding of their mechanism of action, may be because, on the outset both seem unusual, electricity through the head, and a stimulant for hyperactive children. Authored by E. Sidhom, H. Badawy DISCLAIMER The original post is on The BMJ doc2doc website at http://doc2doc.bmj.com/blogs/clinicalblog/#plckblogpage=BlogPost&plckpostid=Blog%3A15d27772-5908-4452-9411-8eef67833d66Post%3Acb6e5828-8280-4989-9128-d41789ed76ee BMJ Article: (http://www.bmj.com/content/347/bmj.f6172). Bibliography Badawy, H., personal communication, 2013 El-Islam, M.F., personal communication, 2013 Thomas R, Mitchell GK, B.L., Attention-deficit/hyperactivity disorder: are we helping or harming?, British Medical Journal, 2013, Vol. 5(347) De Zeeuw P., Mandl R.C.W., Hulshoff-Pol H.E., et al., Decreased frontostriatal microstructural organization in ADHD. Human Brain Mapping. DOI: 10.1002/hbm.21335, 2011) Diagnostic Statistical Manual 5, American Psychiatric Association, 2013 Diagnostic Statistical Manual-IV, American Psychiatric Association, 1994 International Classification of Diseases, World Health Organization, 1992  
Dr Emad Sidhom
over 3 years ago
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7
267

Thou shalt not doubt oneself in front of the patient

As part as my paediatrics attachment, I was having peripheral nervous system bed side teaching. We had spoken over the examination and I was first up to practice on 4 year old Jake. One consultant and 3 other medical students looked on as I worked my way through the examination. My general inspection and impression of the child got approving nods from my colleagues. Phew! Next up was actual exam “two people can’t resist…” I recalled in my head. First up, tone. I assessed this correctly and nothing had gone majorly wrong yet. Relief. Power was next. “ok, so put out your arms up like this and resist me…ok, no, not like that..erm..oh god…I don’t know how to explain it”. My colleagues looked on. The consultant chipped in “tell him to touch his shoulders”. It did the trick and I was able to get through the rest of the examination without too many hiccups. When we had finished, in classic med school fashion I had to reflect on what had just happened and then say something I did good and something I could have done better. My good thing was “I got through it..I mean I remembered everything”. My bad thing was “I wasn’t good at explaining power to him”. My feedback wasn’t the same as my bad thing though. My feedback was “be more confident. You did everything correctly and didn't forget anything. I think it’s a girl thing. You doubt yourselves more than the boys”. Next up was a male medical student’s turn. He did the examination just fine but there were things that I could pick out that he could have done better and being totally objective my examination was better. But there was a major difference. His confidence. He seemed like he knew what he was doing and when he went wrong or missed something out, he just added it to the end of his examination. If I were his examiner, I would have found it difficult to fault him. He appeared confident and as a patient that inspires confidence and a happy patient makes for a happy examiner and good marks. After the session, I got to thinking: am I really incompetent or am I just underestimating my own ability which is making me lack confidence? The fact that a paediatric consultant and all my colleagues told me that my examination was fine, good even, answers the first part. I am not incompetent. So I must be underestimating my own ability. And if I am, is that something that is unique to me? Or are other medical students doing that too? And more interestingly to me, is this something that the female medical students are doing more than their male colleagues?  
Salma Aslam
over 3 years ago
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2
35

A Tale of Guilt and Woe

A Tale of Guilt and Woe June 2012. It was unseasonably miserable. Having successfully fought the battle of Neuro I was all ready for the next onslaught which manifested itself in the form of reproductive and endocrine medicine (us Bristolians have dubbed it EndoRepro which sounds more like an evil Mexican villain). I was making a trip to the library, which, at the time, was around a 30-minute walk away from my student house. This was to do some extra reading. I had my laptop in my bag along with my bags of Haribo for encouragement and when I’d stomached all I could take I began the walk back. It rained. It rained like I have never seen rain before. For 30 minutes, I walked in a torrential down pour and when I arrived at the local Sainsbury’s, they kicked me out because I was dripping that much I posed a health and safety risk on their tiled floor. It was a very miserable day. When I had eventually gotten back into my room and put all my clothes to dry I stood there and thought – why. Why was I doing this to myself? It wasn’t even necessary and I’d put myself through a monsoon to go get some books and read ahead. The reason was because I’d have felt guilty if I hadn’t – I planned to do it, so I was doing it. Guilt is a very powerful thing and it’s something we all encounter as students on a regular basis. When I used to revise for my pre-clinical exams, if I stopped for an hour or two that meant I would have to extend my evening revision to cover the time. I should imagine everyone can relate to this (even those macho folk that profess to be invincible!). Stopping was not an option. In that rain-sodden day I learnt one thing – cut yourself some slack. I never believed it when people used to say to me that “down time” was as important as work time. Down time was wasted time. Down time was a period when I missed that all-important sentence that answered MCQ Q22 on the upcoming exam. At the start of that unit I decided to take things differently. I always timetabled work, but this time I was only doing those timetabled slots if I thought it would be productive. If not, the time was better spent doing other things. If I started and felt like it was too much effort, I didn’t carry on in some marathon-like endurance exercise, I stopped. I refused to let the guilt set in. I turned my ears off to all of the talk in lectures about how much work everyone had or hadn’t done – I refused to let myself be intimidated. So what was the result? I had much better sleep in that time. My head was a lot clearer and I found it about 100 times easier to get up for lectures in the morning. I spent a lot more time doing the things I enjoy which generally upped my motivation. More to the point, I achieved the best set of results in two years in those exams. I only wish I could go back to my fresher self and say: “Cut yourself some slack. Don’t feel guilty. Do your own thing”.  
Lucas Brammar
over 3 years ago
E5d96c4f1ce0f36b5b30c5dcd48dc937
5
612

Hello World, I've been to London's Air Ambulance for a bit...

Hi. Or rather, #HelloMyNameIs Adam. I like trauma, emergency medicine, PHEC, #FOAMed, twitter and scuba diving (but only when there's sunshine involved afterwards). I also like teaching and education, and I'm one of the final year medical students here in Edinburgh. But for 2 months I wasn't. I was one of the London's Air Ambulance elective students down in Whitechapel at the Royal London Hospital. So as an opening gambit, and by some way of an introduction I thought you might want to hear about that. After all, they're much more interesting than I am, and I can't host you for your elective… I managed to swindle my way into a 2 month elective with LAA just before Christmas 2014 and in a word it was pretty great. For those of you thinking of doing it, just go, now, and apply. Then you can come back and read the rest of my ramblings. For the rest of you, here’s what happened. LAA electives are a bit different, unsurprisingly. To cover its 1800-odd missions a year, LAA runs both their trauma service in two flavours: a helicopter (G-EHMS, aka “Mike Sierra” or MEDIC 1) by day and a car (DA “Delta Alpha” 77 or MEDIC 1 NIGHT) by night, (because apparently, whilst sporting and enjoyable for the pilots, landing in metropolitan areas in the dark is too risky, especially with comparatively empty roads). Alongside the trauma service, there is also a Physician Response Unit (PRU) which responds locally to cardiac arrests to provide quality CPR (along with some advanced post-arrest care like cooling and delivery to a cath lab), but for the most part does jobs for the London Ambulance Service which have been deemed probably not to require hospital, but might benefit from a doctor. There’s a 5 year waiting list for day-time flying shifts, and not much less for the rest of their work, so you’re not going to spend 4, 6 or 8 weeks in a helicopter flying round London taking names and saving lives, in fact the helicopter schedule is totally off-limits to students. Instead you’ll start off scheduled for a couple of night shifts each month and there will be opportunities to see a lot of London Ambulance Service, from the “control” at the Emergency Operations Centre (EOC), to time spent with road crews, and, off the back of some of the folk you’ll meet, a route in to observing with some more specialist units too. (More on that in the future if I run out of other ideas!) As well as the “live” experience there are 5 very experienced senior registrars from a variety of backgrounds as well as the 4 full-time LAA consultants, and opportunities to learn both practical skills and theoretical knowledge from them abound. As it turned out, the PRU was probably my favourite part of the elective. You can read about all the trauma that LAA goes to elsewhere, its splashed all over their shiny new website for a start, and many things have been written about their work (I might even write some more later on!) and there’s even a (not great) telly program on Channel 5. But the PRU is just really cool. I hate that word but it is. It fits into a strange, but now expanding niche in emergency care. That is, it serves to lighten the load both on the ambulance service and on the Emergency Departments of London by going out to people who have called 999 and asked for an ambulance but might in fact be better managed in the community. The work is incredibly varied, you can see older folk with a nasty UTI who couldn’t get to see their GP, you can go to a school and glue the head of a kid who’s taken a nasty fall in the playground, or you can end up in some sheltered housing talking to a lady who’s having the roughest of times and trying to deal with borderline personality disorder to boot. The PRU is crewed about half the time by a small group of GPs and EM docs who have been doing it for a while, usually about once a week or so, and quite often in their own time (in between the rota is made up with the LAA docs who usually work the trauma service). They’re kept firmly in line by an experienced LAS paramedic who is seconded over to run this unit, 9-5, 5 days a week, usually for about a year. As a team, they have perfected their ability to assess a patient using the minimal resources available to them, and as we are so often reminded, quite rightly, it turns out to be all in the history. Some interventions are available to them that aren’t available to paramedics, prescribing antibiotics or other drugs to leave with the patient, bypassing the ED for referral straight to specialists, and doing urine dipsticks being the most used among them; but mostly it is the team’s experience and advanced clinical judgement which makes this unit tick, and empowers them to safely leave so many of their patients at home, with care delivered, advice given, and a plan arranged should anything deteriorate. This wasn’t my first rodeo, I’ve been lucky enough to spend some time with the Scottish Ambulance Service up here in Edinburgh, and have spent more than my fair share of time in our Emergency Department, but it was still impressive to see how these guys dealt with the delicate balance of who to leave at home and who might need a further investigation in hospital. Firstly, this is something that anyone who aspires to work in an emergency department should aspire to be comfortable to do. There are going to be a huge number of people who don’t need to be admitted coming through it every day, wherever it is. The faster and more confidently you can identify their problems, treat them, and crucially, reassure them with appropriate advice, good follow up and a safety net, the better experience they will have. Of course much of this comes with experience and training, but tagging along with teams like this is a fine way to start getting some. Secondly, and this is a bit of a stab in the dark, but I think this idea really might take off. The media is almost swamped with stories of A&E departments being overwhelmed, ambulance services are operating at or near capacity, and we’re struggling to work out how we get the public to access the right care provider for their problem at that time. So maybe this is a solution. Maybe doctors, have a new role to play in assessing people earlier rather than people going through so many steps down a potentially unsuitable line of care. We’re starting to see consultants running triage at A&Es, we’re starting to see doctors out in cars like this. Get in on the ground floor guys and girls, I think we’re going to start being “first on scene” a little more often than we might be used to, even if you never leave the hospital.  
Adam Collins
over 3 years ago
5fb0112fcc8dd26852fef76e36f46854
1
30

Dog Fight Against NHS Privatisation

Last Saturday on ITV’s The Jonathon Ross Show, TV personality and comedian Rufus Hound announced that his candidacy for the European Parliamentary elections in May, standing for the single issue National Health Action, NHA, party. This is something that I think we (those of us who value the spirit of the NHS) should all be grateful for. The government is changing the NHS, big business is coming and no one seems that angry. Well at least Rufus is... "David and Jeremy want your kids to die (unless you’re rich)" A provocative title for his accompanying blog post, which of course has helped to fuel discussion. However, I think Mr Hound was right to use this, let’s face it anything that aggravates Toby Young, I am going to look upon gladly. OK, it is dramatised, but based on the evidence we have, it does seem that Misters Cameron and Hunt want an end to the NHS as we know it (an NHS that does indeed do its utmost to prevent any child from dying). We have had top down organisation and privatisation, from parties that promised the opposite pre-election, with an opposition who seem to accept the changes, and had themselves help start the privatisation of the NHS. You can see why Rufus has turned to NHA party, why hasn't everybody else? What will Rufus achieve? To be honest I don’t think a lot. If he actually manages to be elected, as a MEP his campaigning will be in Brussels not Westminster. There is one key piece of legislation that the NHA will be looking to stop, the EU/US free trade agreement, which if passed including the NHS will mean that privatisation will not be reversible. The health and social care act opened up contracting opportunities in the NHS for multinationals and the free trade agreement will mean that future governments will be powerless to reverse the private contracting of these overseas companies. The three main parties are broadly supporting this agreement. Good Luck Rufus. Rufus has already achieved something though. He has brought the issue he feels so strongly about to the public’s attention, in a way that no backbencher, lobbyist or journalist ever could. Since his announcement NHA party has been discussed across national media. People realise the NHS is being changed and are starting to speak up. I hate to think of the NHS going the same way as Britain’s utilities. Shareholders and profit should be nothing to do with the health and well-being of the country. Apparently not all clowns are evil. Rufus Hound: Comedian, Radio 4 presenter, argumentalist, and now would be politician. Some further reading: Rufus's blog http://rufushound.wordpress.com/ Trade secrets: will an EU-US treaty enable US big business to gain a foothold? http://www.bmj.com/content/346/bmj.f3574 It’s time to get serious about NHS, says comedian Rufus Hound. http://www.independent.co.uk/news/uk/politics/its-time-to-get-serious-about-nhs-says-comedian-rufus-hound-9086435.html  
Joe de Silva
over 3 years ago
Adfb5f75e4bdcde2950f9a75327fa46f
1
32

Consultantitis - Part 1

consultant NOUN a person who provides expert advice professionally: he acted as campaign consultant to the president [OFTEN AS MODIFIER] British a hospital doctor of senior rank within a specific field: a consultant paediatrician -itis SUFFIX forming names of inflammatory diseases: cystitis, hepatitis (Origin - from Greek feminine form of adjectives ending in -it?s (combined with nosos 'disease' implied) ) You may not be surprised to hear that the way in which I recently heard the term 'consultantitis' used cannot be understood to mean 'inflammation of the senior hospital doctor'. Although, I wish it was. Professionalism, compassion, transparency, teamwork and communication - all terms that appear to be used with an increasing regularity within the NHS. These are concepts that are not merely taught but preached to medical students today. Why? Well it is nit merely the work of a heavily publicised inquiry into a foundation trust, neither is it the upshot of the medical profession's own Voldemort - he who must not be named (except I will name him - Harold Shipman). Is it then an attempt to heal the wounds within our national health service from within? I hope so. Yet, there are countless more 'isms' and other terms being muttered under the breath of healthcare professionals all over the country. 'Consultantitis' is one that fills me with sadness for one reason in particular: it suggests that those at the top are at the core of some of the problems. Ponder over that for a while, I intend to explain myself further in my next blog post. To be continued****.  
Chantal Cox-George
over 3 years ago
7dad8aa69a417a211c780bd51b37a06d
3
48

Dealing with Personal Illness in Med School

Hey guys! I’m Nicole and I’m a second year medical student at Glasgow University. I’ve decided to start this blog to write about my experiences as a med student and the difficulties I encounter along the way, hopefully giving you something you can relate to. Since June of last year I have been suffering with a personal illness, with symptoms of persistent nausea, gastric pain and lethargy. At first I thought it was just a bug that would pass on fairly quickly, but as the summer months went on it was clear that this illness wasn’t going to disappear overnight. I spent my summer going through a copious amount of medications in hope that I’d feel better for term starting. I visited my GP several times and had bloods taken regularly. After 2 months, I finally got given a diagnosis; I had a helicobacter pylori infection. I started eradication therapy for a week and although it made my symptoms worse, I was positive would make me better and I’d be well again within the week. The week passed with no improvements in my condition. Frustrated, I went back to my GP who referred me for an endoscopy. Term started back the next week and despite feeling miserable I managed to drag myself out to every lecture, tutorial and lab. Within a few weeks I began to fall behind in my work, doing the bare minimum required to get through. Getting up each morning was a struggle and forcing myself to sit in lectures despite the severe nausea I was experiencing was becoming a bigger challenge each day. In October I went for my endoscopy which, for those of you that don't know, is a horribly uncomfortable procedure. My family and friends assured me that this would be the final stage and I’d be better very very soon. The results came back and my GP gave me a different PPI in hope that it would fix everything. I waited a few weeks and struggled through uni constantly hoping that everything would magically get better. I gave up almost all my extra-circular activities which for me, the extrovert I am, was possibly the hardest part of it all. I wanted to stay in bed all the time and I become more miserable every day. I was stressing about falling behind in uni and tensions began to build up in my personal life. It got to the point where I couldn’t eat a meal without it coming back up causing me to lose a substantial amount of weight. I got so stressed that I had to leave an exam to throw up. I was truly miserable. I seen a consultant just before Christmas who scheduled me in for some scans, but it wasn’t until January. I was frustrated at how long this was going on for and I thought it was about time I told the medical school about my situation. They were very understanding and I was slightly surprised at just how supportive they were. I contacted my head of year who arranged a visit with me for January. During the Christmas break I had a chance to relax and forget about everything that was stressing me. I got put on a stronger anti-sickness medication which, surprisingly, seemed to work. The tensions in my life that had built up in the last few months seemed to resolve themselves and I began to feel a lot more positive! I met with my head of year just last week who was encouraged by my newly found positive behaviour. We’ve agreed to see how things progress over the next few months, but things are looking a lot brighter than before. I’ve taken on a new attitude and I’m determined to work my hardest to get through this year. I’m currently undertaking an SSC so I have lots of free time to catch up on work I missed during the last term. My head of year has assured me that situations like the one I’m in happen all the time and I’m definitely not alone. I feel better knowing that the medical school are behind me and are willing to help and support me through this time. The most important thing I have taken from this experience is the fact that you’ll never know the full extent of what a patient is going through. Illness effects different people in different ways and it may not just be a persons health thats affected, it can affect all aspects of their life. This experience has definitely opened my eyes up and hopefully I’ll be able to understand patients’ situations a little better.  
Nicole Mooney
over 3 years ago
Cbf394271e61275f1d84eb8e68dc2b57
5
63

What it means to be an Australian with skin cancer

Each year on the 26th of January, Australia Day, Australians of all shapes, sizes and political persuasions are encouraged to reflect on what it means to be living in this big, brown, sunny land of ours. It is a time to acknowledge past wrongs, honour outstanding Australians, welcome new citizens, and perhaps toss a lamb chop on the barbie (barbecue), enjoying the great Australian summer. It is also a time to count our blessings. Australians whinge a lot about our health system. While I am certainly not suggesting the model we have is anywhere near perfect, it could be a whole lot worse. I recently read this NY times article which talks about the astronomical and ever-rising health care costs in the US and suggests that this, at least sometimes, involves a lack of informed consent (re: costs and alternative treatment options). The US is certainly not the “land of the free” when it comes to health care. There are many factors involved, not least being the trend in the US to provide specialised care for conditions that are competently and cost-effectively dealt with in primary care (by GPs) in Australia. The article gives examples such as a five minute consult conducted by a dermatologist, during which liquid nitrogen was applied to a wart, costing the patient $500. In Australia, (if bulk billed by a GP) it would have cost the patient nothing and the taxpayer $16.60 (slightly higher if the patient was a pensioner). It describes a benign mole shaved off by a nurse practitioner (with a scalpel, no stitches) costing the patient $914.56. In Australia, it could be done for under $50. The most staggering example of all was the description of the treatment of a small facial Basal Cell Carcinoma (BCC) which cost over $25000 (no, that is not a typo – twenty five THOUSAND dollars). In Australia, it would probably have cost the taxpayer less than $200 for its removal (depending on exact size, location and method of closure). The patient interviewed for the article was sent for Mohs surgery (and claims she was not given a choice in the matter). Mohs (pronounced “Moe’s” as in Moe’s Tavern from The Simpsons) is a highly effective technique for treating skin cancer and minimises the loss of non-cancerous tissue (in traditional skin cancer surgery you deliberately remove some of the surrounding normal skin to ensure you’ve excised all of the cancerous cells) . Wikipedia entry on Mohs. This can be of great benefit in a small minority of cancers. However, this super-specialised technique is very expensive and time/ labour intensive. Perhaps unsurprisingly, it has become extremely popular in the US. ”Moh’s for everything” seems to be the new catch cry when it comes to skin cancer treatment in the US. In the past two years, working very part time in skin cancer medicine in Australia, I have diagnosed literally hundreds of BCCs (Basal Cell Carcinomas). The vast majority of these I successfully treated (ie cured) in our practice without needing any specialist help. A handful were referred to general or plastic surgeons and one, only one, was referred for Mohs surgery. The nearest Mohs surgeon being 200 kilometres away from our clinic may have something to do with the low referral rate, but the fact remains, most BCCs (facial or otherwise), can be cured and have a good cosmetic outcome, without the need for Mohs surgery. To my mind, using Mohs on garden variety BCCs is like employing a team of chefs to come into your kitchen each morning to place bread in your toaster and then butter it for you. Overkill. Those soaking up some fine Aussie sunshine on the beach or at a backyard barbie with friends this Australia Day, gifting their skin with perfect skin-cancer-growing conditions, may wish to give thanks that when their BCCs bloom, affordable (relative to costs in the US, at least) treatment is right under their cancerous noses. Being the skin cancer capital of the world is perhaps not a title of which Australians should be proud, but the way we can treat them effectively, without breaking the bank, should be. Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/  
Dr Genevieve Yates
over 3 years ago
374b98ea4b6048c7616fa64fd024f0eb
2
44

Imagine a world where procrastination became a productive pastime…

Imagine a world where procrastination became a productive pastime… Procrastination, as it stands, is a core feature of the ‘human condition’ and most would argue that it is here to stay. However, what if we could hijack the time we spend playing Candy Crush saga and trick ourselves into contributing towards something tangible. Today, I wish to explore this possibility with you. The phrase ‘gamification’ is not a new or made up word (I promise) although I agree it does sound jarring and I certainly wouldn’t recommend trying to use it in a game of scrabble (yet). The phrase itself refers to the process of applying game thinking and game mechanics to non-game contexts to engage users in solving problems. For our purposes and for the purposes of this blog ‘problems’ will equate to promoting healthy living for our patients and maintaining our own medical education. For one reason or another, most people show addictive behaviour towards games especially when they incorporate persistent elements of progression, achievement and competition with others. The underlying psychology won’t be discussed here; call it escapism, call it procrastination, call it whatever you will. What I want you to realise is that every day millions of people spend hours tending to virtual farms and cyber families whilst competing vigorously with ‘online’ friends. If we can take the addictive aspects of these popular games and incorporate them in to the non-game contexts I indicated to above, we could potentially trick ourselves, and even perhaps our patients, into a better way of life. The first time I heard the phrase ‘gamification’ was only last year. I was in Paris attending the Doctors 2.0 conference listening to talks on how cutting edge technologies and the Internet had been (or were going to be) incorporated into healthcare. One example that stood out to me was a gaming app that intended to engage people with diabetes to record their blood sugars more regularly and also compete with themselves to achieve better sugar control. People who have the condition of Diabetes Mellitus are continuously reminded of their diet and their blood sugar levels. I am not diabetic myself, but it is not hard to realise that diet and sugar control is going to be an absolute nightmare for people with diabetes both from a practical and psychological standpoint. Cue the mySugr Compainion, an FDA approved mobile application that was created to incorporate the achievement and progression aspects of game design to help encourage people with diabetes to achieve better sugar control. The app was a novel concept that struck a chord with me due to its potential to appeal to the part in everyone’s brain that makes them sit down and play ‘just one more level’ of their favorite game or app. There are several other apps on the market that are games designed to encourage self testing of blood sugar levels in people with diabetes. There is even a paediatric example titled; “Monster Manor,” which was launched by the popular Sanofi UK (who previously released the FDA / CE approved iBGStar iPhone blood glucose monitor). So applying aspects of game design into disease management apps has anecdotally been shown to benefit young people with Diabetes. However, disease management is just one area where game-health apps have emerged. We are taught throughout medical school and beyond that disease prevention is obviously beneficial to both our patients and the health economy. Unsurprisingly, one of the best ways to prevent disease is to maintain health (either through exercise and / or healthy eating). A prominent example of an app that helps to engage users in exercising is ‘RunKeeper,’ a mobile app that enables people to track and publish their latest jog-around-the-park. The elements of game design are a little more subtle in this example but the ability to track your own progress and compete with others via social media share buttons certainly reminds me of similar features seen in most of today’s online games. Other examples of ‘healthy living apps’ are rife amongst the respective ‘app stores,’ and there seems to be ample opportunity for the appliance of gamification in this field. An example might be to incorporate aspects of game design into a smoking cessation app or weight loss helper. Perhaps the addictive quality of a well designed game-app could overpower the urge for confectionary or that ‘last cigarette’… The last area where I think ‘gamification’ could have a huge benefit is in (medical) education. Learning and revising are particularly susceptible to the rot of procrastination, so it goes without saying that many educational vendors have already attempted to incorporate fresh ways in which they can engage their users to put down the TV remote and pick up some knowledge for the exams. Meducation itself already has an area on its website entitled ‘Exam Room,’ where you can test yourself, track your progress and provide feedback on the questions you are given. I have always found this a far more addictive way to revise than sitting down with pen and paper to revise from a book. However, I feel there could be a far greater incorporation of game design in the field of medical education. Perhaps the absolute dream for like-minded gamers out there would be a super-gritty medical simulator that exposes you to common medical emergencies from the comfort of your own computer screen. I mean, my shiny new gaming console lets me pretend to be an elite solider deep behind enemy lines so why not let me pretend and practice to be a doctor too? You could even have feedback functionality to indicate where your management might have deviated from the optimum. Perhaps more sensibly, the potential also exists to build on the existing banks of online medical questions to incorporate further aspects of social media interaction, achievement unlocks and inter-player competition (because in case you hadn’t noticed, medics are a competitive breed). I have given a couple of very basic examples on how aspects of game design have emerged in recent health-related apps. I feel this phenomenon is in its infancy. The technology exists for so much more than the above, we just need to use our imagination… and learn how to code.  
Dr. Luke Farmery
over 3 years ago
C14d2a462cbc9d02968de64b51435b94
5
43

Commitment Issues

I recently read a question on meducation posted around a year ago, the jist of which was “as a medical student, is it too early to start developing commitment to a specialty?” I.e. “even though I haven’t graduated yet, should I start building a portfolio of experience and evidence to show that specialty X is what I really want to do?” MMC revolutionised (for better or worse) the medical career structure forcing new graduates to decide on a career path much earlier. Many have appreciated the clear delineation of their career pathway. Others have found the 15 month period between leaving university and applying for specialty training too short to make an informed decision (just ask the 10% of FY2s that took a career break last year (i)). Whether right or wrong, there is now less time to rotate round ‘SHO’ jobs, decide on a career and build a CV capable of winning over an interview panel. You’ll probably find you’re in one of 2 camps at university: Those who are absolutely 110% certain there is nothing they want to do, ever, other than specialty X, or Those who really like specialty X, but also like specialties W, Y and Z and haven't made up their minds (A few people find themselves feeling they don’t want to be part of any medical career, but that’s for another post.) Students identifying with the first statement are usually concerned they will not get enough general experience, or that they will be stuck with their decision if they change their minds later on. Those who are leaning more towards statement 2 may not build as strong a body of evidence for any one specialty; however it’s possible to get involved in activities either relevant to a few career options, or several specialty-specific activities and subsequently edit the CV for a specific interview. The key message is that whether you think you have your career mapped out or not, medical school is the perfect time to start collecting evidence that you’re interested in a career in a particular specialty: time for extra-curricular activities only becomes scarcer when you have a full time job complete with working long days, nights and weekends. Your experiences at medical school can then be supplemented with taster weeks, teaching and judicious use of your study budget for training days and conferences; bear in mind that all specialties allow at least 3 years* following FY2 before starting specialty training which can be used for gaining further experience (but be prepared to justify and defend your actions). It’s also important to consider the manner in which individual specialties require such a commitment to be demonstrated: In general terms, the more niche and/or competitive the specialty, the more they will want you to demonstrate that you a) really know what the job entails and b) have made a concerted effort to further your knowledge of the subject. To get a job in neurosurgery for example, which is not only niche but had a completion ratio of 4.9 in 2013(ii) you’ll need to have gone to courses relevant to neurosurgery and have achievements related to the specialty such as a neurosurgical elective, attachment or taster experience(iii). Some specialties assess commitment in a variety of situations e.g. the radiology interview this year had stations on the general overview and future of radiology as a career, a CV based demonstration of commitment to specialty as well as a station requiring the interpretation of images. General Practice on the other hand which in its very nature is very broad, at no point allocates marks specifically for commitment to specialty (or anything else on a CV for that matter) as it is entirely dependent on an exam (SJTs and clinical questions) and skill-based stations at a selection centre. The person specification* details what is expected and desirable as demonstration of commitment in each specialty. So, how do you actually show you’re committed to a specialty? It may be pretty obvious but try to get a consistent and well-rounded CV. Consider: • Joining a student committee or group for your specialty. If there isn't one at your university, find some like-minded people and start one • Asking the firms you work for if you can help with an audit/research even if data collection doesn’t sound very interesting • Finding a research project (e.g. as part of a related intercalated or higher degree) • Prizes and examinations relevant to the specialty • Developing a relevant teaching programme • Selecting your selected study modules/components, elective and dissertation with your chosen specialty in mind • Going to teaching or study days aimed at students at the relevant Royal College Remember it’s not just what you’ve done but also what you’ve learnt from it; get into a habit of reflecting on what each activity has helped you achieve or understand. This is where most people who appear to have the perfect CV come unstuck: There will always be someone who has more presentations and publications etc. etc. but don’t be put off that it means they are a dead cert for the job. Whatever you do, make sure you have EVIDENCE that you’ve done it. Become a bit obsessive. Trust me, you forget a lot and nothing counts if you can’t prove it. Assessing commitment to specialty aims to highlight who really understands and wants a career in that specialty. From my own recent experience however, just identifying experiences explicitly related to a specific specialty ignores the transferable and clinically/professionally/personally important skills one has that would make them a successful trainee. I’d be very interested in your views on ‘commitment to specialty’: for example do you think the fact someone has 20 papers in a given specialty means they are necessarily the best for the job? Or are you planning to take a year out post-FY2 to build on your CV to gain more experience? Let us know! References *See person specifications for specialty-specific details at http://specialtytraining.hee.nhs.uk/specialty-recruitment/person-specifications-2013/ i. http://www.foundationprogramme.nhs.uk/download.asp?file=F2_career_destination_report_November_2013.pdf ii. http://specialtytraining.hee.nhs.uk/wp-content/uploads/sites/475/2013/03/Specialty-Training-2013.pdf iii. http://specialtytraining.hee.nhs.uk/wp-content/uploads/sites/475/2013/03/2014-PS-NEUROSURGERY-ST1-1.02.pdf  
Dr Lydia Spurr
over 3 years ago
7e7c0fa25aa56974460d6fd862d685ff
9
132

A Comedy of Errors

Great people make mistakes. Unfortunately, medicine is a subject where mistakes are not tolerated. Doctors are supposed to be infallible; or, at least, that is the present dogma. Medical students regularly fall victim to expecting too much of themselves, but this is perhaps not a bad trait when enlisting as a doctor. If it weren’t for mistakes in our understanding, then we wouldn’t progress. Studying a BSc in Anatomy has exposed me to the real world of science – where the negative is just as important as the positive. What isn’t there is just as important as what is. If you look into the history of Anatomy, it truly is a comedy of errors. So, here are three top mistakes by three incredibly influential figures who still managed to be remembered for the right reasons. 3. A Fiery Stare Culprit: Alcmaeon of Croton Go back far enough and you’ll bump into someone called Alcmaeon. Around the 5th century, he was one of the first dissectors – but not an anatomist. Alcmaeon was concerned with human intellect and was desperately searching for the seat of the soul. He made a number of major errors - quite understandable for his time! Alcmaeon insisted that sleep occurs when the blood vessels filled and we wake when they empty. Perhaps the most outrageous today is the fact that he insisted the eyes contained water both fire and water… Don’t be quick to mock. Alcmaeon identified the optic tract, the brain as the seat of the mind (along with Herophilus) and the Eustachian tubes. 2. Heart to Heart Culprit: Claudius Galen Legend has it that Galen’s father had a dream in which an angel/deity visited him and told him that his son would be a great physician. That would have to make for a pretty impressive opening line in a personal statement by today’s standards. Galen was highly influential on modern day medicine and his treatise of Anatomy and healing lasted for over a thousand years. Many of Galen’s mistakes were due to his dissections of animals rather than humans. Unfortunately, dissection was banned in Galen’s day and where his job as physician to the gladiators provided some nice exposed viscera to study, it did not allow him to develop a solid foundation. Galen’s biggest mistake lay in the circulation. He was convinced that blood flowed in a back and forth, ebb-like motion between the chambers of the heart and that it was burnt by muscle for fuel. Many years later, great physician William Harvey proposed our modern understanding of circulation. 1. The Da Vinci Code Culprit: Leonardo Da Vinci If you had chance to see the Royal Collection’s latest exhibition then you were in for a treat. It showcased the somewhat overlooked anatomical sketches of Leonardo Da Vinci. A man renowned for his intelligence and creativity, Da Vinci also turns out to be a pretty impressive anatomist. In his sketches he produces some of the most advanced 3D representations of the human skeleton, muscles and various organs. One theory of his is, however, perplexing. In his sketches is a diagram of the spinal cord……linked to penis. That’s right, Da Vinci was convinced the two were connected (no sexist comments please) and that semen production occurred inside the brain and spinal cord, being stored and released at will. He can be forgiven for the fact that he remarkably corrected himself some years later. His contributions to human physiology are astounding for their time including identification of a ‘hierarchal’ nervous system, the concept of equal ‘inheritence’ and identification of the retina as a ‘light sensing organ’. The list of errors is endless. However, they’re not really errors. They’re signposts that people were thinking. All great people fail, otherwise they wouldn’t be great.  
Lucas Brammar
over 3 years ago
7f9d80a73368e68d55000f8318955ff3
6
28

MedEd Technology: Twitter

Recently, I made a short video about where I see the use of technology in MedEd (take a look), and when asked to write for Meducation, I thought it would be great to get people thinking about technology and its uses in medical school. Social media – easy to use on smart phones, instant access to resources and thousands of likeminded people. Seems like a good place for medical education? Uses Now Students are often at the forefront of technology – we’ve grown up with it, and so many staff and lecturers within medical schools will be lagging. This makes it difficult to integrate technology into the curriculum, especially before technology has moved on. This is potentially why the use of twitter remains informal, and that may be its charm. By remaining informal, it means students can ask questions and get involved with hashtags without the constraints of marks and tests. Revision questions, mnemonics, diagrams and pictures are all over twitter, if you know where you’re looking. Here’s my current list of useful people in medical education to follow, and the hashtags I’m following: Advantages Easy and quick to set up an account Thousands of medics around the world – ask questions, network and share resources Can get involved as little or as much as you like Disadvantages Mixing social life and education – medicine can already take over your life, do we really want to be thinking about it in our spare time? And do you want your lecturer to follow you? Privacy – can only make full use of twitter with an open account Getting students involved – many students don’t want twitter, so if it was to be used formally in education, there would have to be incentives GMC advice on the use of social media can be found here. People to follow Hashtags to follow @knowmedge #quclms @meducation #twitfrig @twitfrg #FOAMed @MedEdNcl #MedEd @MedFinalsRev Content @patientuk Content I’ll update the list as it changes – leave a comment if you find anything good! Future Uses But can it be used in medical school? In my university, some lecturers put up a twitter feed, using the course name as a hashtag, where students ask questions without shouting out. The hashtag can be used after that, to ask questions and share relevant resources. I like this idea – but could it work in medical education? Maybe in early years it could be used in the same way, but once students are on placement it gets harder. While everyone is in different hospitals, it could be a good way to integrate learning, check students are meeting objectives and ask questions throughout to check understanding. Maybe its only use is announcements – “placement letters must be handed in by the 21st Jan”. The other question is, how long can twitter last for? We’re already seeing a gradual decline in Facebook, so it may not be worth medical schools investing time and money into social media. Are you on twitter? Do you keep it purely social or do you mix in medicine? Would you like to see your lecturers on board and tweeting you questions? At the moment, I’m not too sure – I keep my twitter for medicine, answering the questions from @knowmedge, saving the mnemonics from @medfinalsrev, but I’m not sure how much I would get involved if my medical school used it officially… Written by Anna Willis Anna is a Medical Student at Sheffield University and is a Resident Blogger for Meducation Follow Anna on Twitter: @AnnaPeerMedEd  
Anna W
over 3 years ago
56d856b670301accdbdd229f7344d65d
7
84

Hypo-Politicosis

Hypo-politicosis = A behavioral condition where political thought and action is dangerously below an optimal range. Leading to the ostrich phenomenon of delusionary belief that there is nothing outside of medicine. In an age of ever great openness, communication and democratic rights, the population of the western world is disengaging with political ideology, political debate and political engagement. This disengagement is nowhere more prevalent than in the UK. The total membership of all the political parties are at the lowest since they were formed. There are less trade unionist today than a century ago. And most importantly the proportion of people that vote regularly is at an all-time low. Surely, this is a sign of a dysfunctional democracy? Can we truly call it a democracy if the state’s citizens have no interest or control over how the state is run? What worries me even more than this dire situation, is the lack of interest in politics from fellow medical students. If you were to sit in a bar in a medical school city, I am sure you would be able to hear groups of medical students unwinding over a pint and discussing some political issues. But those political issues almost always evolve around medicine, such as abortion laws, public health initiatives, doctor’s pay and the re-structuring of the NHS. This insular mind set worries me because there is more to life than medicine! And while so much of our lives may be taken up with the learning and practice of medicine, our lives will be affected by so much more, and before medical school we all had to take an interest in so much more just to get an interview. Do you remember having the time and inclination to take an interest in something that wasn’t medicine? Like reading history or poetry? This insular mindset is detrimental because it means that as a demographic group we may not engage as fully as we should do with the rest of society, this could be bad for us but more importantly bad for the greater society. If medics become too disengaged in the greater political debates then we may find that society decides that doctors are easy targets and easy scapegoats. We may find our working lives extended, our social lives curtailed, our pensions decimated and our earning power diminished because we did not engage with the public and discuss these issues openly. We may also lose influence with the government if medics don’t vote for their local MPs, question their local party officials and fight our corner over important issues via the BMA. The other side of this coin is that medics are selected from some of the brightest in the country, educated at great expense by the state, trained and employed by the state and pay a huge amount of tax to the state. If we engage in politics less then society as a whole may suffer from a lack of highly intelligent, highly educated individuals, who should hopefully have a strong social conscience and interest in well run state, from putting their thinking skills to good use on societal problems. Dr Liam Fox is a conservative back-bench MP and use to be in the shadow cabinet. He has used the skills he developed as a doctor to try and follow an evidence based political career. He recently released a book called “Rising tides” (http://www.amazon.co.uk/Rising-Tides-Facing-Challenges-New-ebook/dp/B00CUE0DKQ) which analyses many of the world’s current political issues and I would highly recommend as many people as possible read it. I also hope that in future I can walk into a bar, meet some medical colleagues and talk about an issue that affects more of society than just medics! How about using a scientific approach to discuss how Britain’s education system could be improved? Or how Britain could use its welfare resources better to decreased homelessness (which would also reduce a burden on A and E’s)?  
jacob matthews
over 3 years ago
10f8d3ebe679f366824783e2dbae9c95
5
142

Points mean Prizes (and jobs)

Thousands of doctors are currently preparing portfolios and stressing about situational judgements as they go into core and specialty training interviews. As a medical student I wasn’t even aware when these interviews were and had only the briefest imaginings of what they might entail. Even at finals, specialty applications felt a million miles away; but it’s as if you’ve only just got through the misery of MTAS and you’re suddenly an F2 realising that the last 15 months have, to your surprise, disappeared. Yes, the interview is certainly a stressful situation, and for many medics it’s only the second ‘proper’ interview they’ve ever had. Time pressures, the scope of stations and performing under the watchful eye of the great and good of the medical profession only add to the stress. But, there are ways to make this process bearable, and, dare I say it, enjoyable (kind of). The most important step is preparation. Not just the preparation that starts in the days to weeks before the interview; this should be for refining your skills, getting your answers super-slick and getting to know yourself inside-out. Preparation starts at university (and no, which school you’re in doesn’t make a single difference). What the interviewers are looking for can be found in the person specification unique to each specialty (found at http://bit.ly/1eWF6aN). I.e. if you know you were born to perform heart surgery, start looking at what the interviewers for cardiothoracics are looking for. Even if you’re completely confused about your career path, it’s time to start thinking. Many specialties still have a short-listing stage dependent on the application form. Whether assessed on the form or at interview each specialty will (generally) award points for other/higher degrees, publications, presentations, prizes, teaching experience, audit and ‘commitment to specialty’. At the CT1/ST1 stage it doesn’t matter what subject area you published/presented/taught in etc. to score in that section; but having something relevant will help you discuss your commitment to that specialty. ‘Relevant’ in itself is misleading however; every experience is likely to be relevant when you identify the transferable skills involved and what you learned from the experience. Some specialties are stricter and you’ll need demonstrable evidence that you haven’t just applied on a whim. These tend to be the more competitive specialties which demand evidence you’ve had a really good look at what the job involves and have taken steps to broaden your knowledge. There is typically also at least one skills station which may be general (e.g. breaking bad news to a patient) or specialty-specific (e.g. interpreting images for radiology) but are still based on applicants demonstrating they fit the person specification. Many of the mark schemes are also freely available on the relevant Royal College website, and I encourage you to have a look and see where you could get a few more points (or give yourself a pat on the back that you couldn’t). It’s unlikely that the mark scheme/person spec. will be exactly the same every year, but the general overview is enduring. NB. The GP application is a bit different, but that’s for another post. The take home message is get involved early on, and be involved consistently. It may eat up some of your free time but you’ll appreciate it as soon as you look at the application form. If you’re struggling for practical ideas, take a look at the Royal College and specialty trainee websites for inspiration (some, for example the Royal College of Radiologists, have great audit ideas). The RSM and each medical school have a list of available prize essays and exams. A wise person once said to me “there’s no such thing as a wasted conversation”: Speaking to trainees and consultants about how they got to where they are not only gives you great insight into what they do but being friendly and enthusiastic can open up doors for you to help in audits and publications. And the final tip? Write everything down. Not only will this stand you in good stead as a safe doctor, but you’ll be surprised how much you can forget in a very short time. Then, unlike me, you won’t have to spend ages trying to think of reasonable examples of ‘when I dealt with stress’. Written by Lydia Spurr, FY3 Doctor Lydia is a Resident Meducation Blogger  
Dr Lydia Spurr
over 3 years ago
875c1fd8d4d4b856d4614d494e1b79cb
2
29

How Health Evangelism Can Give Us More Out of Life Than We Can See

As more and more knowledge about our health is becoming evident, people everywhere are looking at new and innovative ways like Health Evangelism as a means of treatment. Getting a clean bill of health is a challenge for many people these days. For that reason many people are looking at different types of health care options that may stray a bit from the traditional but still give the patient needed relief from their physical problems. This is where new approaches have come in to help gain control of many of the medical issues that many people have to face. What is Health Evangelism? The expression ‘health evangelism’ is defined as an applying of the principles of healthful living in a way that includes physical laws that have been set forth by God to act in our lives. This is simply recognizing that God, as the provider of life, created us to function in a very specific way. Many of the physical health problems that we face are a direct result of going against those inborn laws that he set forth. Health Evangelism is a means of identifying those laws and not only using them within but passing them on to others in an evangelizing work. Benefits of Health Evangelism Your knowledge of the physical laws that he has set in motion have been instrumental in helping to improve a number of major health concerns of many people. For example, just coming to an understanding of your diet and how certain foods were designed to nourish your body can help to improve blood sugar health, cholesterol levels, cardiovascular conditioning, and your immune system among other things. Higher Spiritual Plane As you see how this understanding has had a major impact on the improvement of your health you will reach a point where, you will develop a personal relationship with your creator and the things he’s provided. Your care for your health and physical well-being will not be just taking care of yourself but you will come to view it as a part of your worship to your spiritual benefactor. By doing this, you will have reached a higher spiritual level that you may not have discovered otherwise. We have all been wonderfully made and our appreciation for our creation is a demonstration that we are part of something that extends far beyond our own personal world. Learning the details of Health Evangelism can open our eyes to many of the things unseen from the world around us. For more information, visit http://www.pambrarmd.com/contact.php.  
Enrica
over 3 years ago
2f09e0634f8aab8b9f76f478b2fbd689
2
313

I hate being on-call - I’m just not good at sleeping on the job

BOXING Day, 1.30am. “Are you the doctor on call?” I wrenched my reluctant brain from its REM state. “Yes.” “I’m worried about my wife. She’s 16 weeks pregnant and very gassy.” “Gassy?” “Burping and farting. Smells terrible! It’s keeping us both awake. I’m worried it could be serious.” By the time I ascertained that there were no sinister symptoms and that the likely culprit was the custard served with Christmas pudding (the patient was lactose intolerant), I was wide awake. My brain refused to power down for hours, as if out of spite for being so rudely aroused. I have a confession to make. When the Australian Federal Government announced that it was planning to abolish after-hours practice incentive payments, I was delighted. I know, I know, I should have been outraged along with the rest of you. After all, the RACGP predicted that after-hours care would be decimated if incentives were removed. Comparisons were made with the revamp of the UK system in 2004, which led to 90% of the profession opting out of after-hours work. Much as I sympathised, I was secretly rubbing my hands together with selfish glee. Surely this would mean that our semi-rural practice would stop doing all of our own on-call and free me from my after-hours responsibilities? I detest being on call. I loathe it with a passion completely out of proportion to the imposition it actually causes. I’m on call for the practice and our local hospital only once a week and the workload isn’t onerous. Middle-of-the-night calls aren’t all that frequent, but my sleep can be disturbed by their mere possibility, leaving me tired and cranky. If I’m forced suddenly into “brain on, work mode” by a phone call, I can kiss hours of precious slumber goodbye. I love to sleep, but, as with drawing and tennis, I’m not very good at it. I gaze with envy at those lucky devils who nap on public transport and fight malicious urges to disturb their peaceful repose. If I’m not supine, in a quiet, warm room, with loose-fitting clothing, a firm mattress and a pillow shaped just-so, I can forget any chance of sleep. Let’s just say I can relate to the Princess and the Pea story. I bet she wouldn’t have coped well with being phoned in the middle of the night either. If these nocturnal calls were all bona fide emergencies, I wouldn’t mind so much. It’s the crap that really riles me. I’ve received middle-of-the-night phone calls from patients who are constipated, patients with impacted cerumen (“Me ear’s blocked, Doc. I can’t sleep”) and patients with insomnia who want to know if it’s safe to take a second sedative. The call that took the on-call cake for me, though, was from a couple who woke me at 11.30 one night to settle an argument. “My husband says that bacteria are more dangerous than viruses but I reckon viruses are worse. After all, AIDS is a virus. Can you settle it for us so we can get some sleep? It would really help us out.” I kid you not. Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com  
Dr Genevieve Yates
over 3 years ago
148f2e44f788073c38370c3d9bd35366
7
34

Pearls of Wisdom

If I had a penny, okay a pound, for every time a patient responded to the request to practice examining them said, 'Well, we all gotta learn', I would be a very rich medical student. (I'd like to add that this is said in a strong West-country accent, just so that you feel like you're really there.) I'm sure that the majority of my colleagues would agree. Today has been no different except for the fact that one of the patients I met described themselves as a 'whistleblower'. It was like my subconscious slapping me around the face and telling me to stop procrastinating. Why, you ask? Well I'm starting to get a little nervous actually, in exactly two weeks I'll be presenting my thoughts on whistleblowing (you might remember me going on about this during dissertation season) to a load of academics and healthcare professionals. My sphincters loosen up at the thought of it* Within five minutes of meeting this patient, they had imparted their wise words on me 'Chantal, just remember when you become a doctor - if you're absolutely sure that you're right about something then never be afraid to speak up about it.' Like music to my ears. Well, until he told me that he was convinced that 'cannabis cures all ills.' Each to their own. *I sincerely apologise, poor medic joke. Yuck. Written by Chantal Cox-George, 3rd Year Med Student at University of Bristol  
Chantal Cox-George
over 3 years ago
2a2de333754d7ce08170f7ebf5915d9f
8
14

Patients or Patience?

Walking into a cubicle, introducing myself and acquiring a patient's permission to ask them a few questions about what brought them into hospital and then to examine them. Sounds simple enough, until you're in A&E, the patient is seriously ill and you're the first person to see them. I learned the hard way this week, spending an hour with a patient only to realise that they were so confused (in the medical - not the academically challenged - sense) that the history that I had taken was essentially null & void. It was to be their partner and carer who would provide me with the history that would allow qualified members of the healthcare profession to attempt to make their loved one better. Lesson 1. Sometimes the patient isn't the best person to tell you what's wrong with them. Lesson 2. Sometimes they are. On the flip side, some patients LOVE a good chinwag! They'll tell you everything about their health, family and day-to-day life without a moments pause. And it takes some guts to interrupt them mid-flow.. Despite the obvious time constraints, these are my favourite interactions. I often wonder how I find myself in such an honourable position. Why do people feel they can share so much of their life story with me? Some laugh, some cry, others just want to vent their frustrations. Either way I'm there, I'm listening, and most importantly I'm learning. Written by Chantal Cox-George, 3rd Year Med Student at University of Bristol  
Chantal Cox-George
over 3 years ago
Cdaab72b4b1e280a287b267872f7617a
4
188

Surprising places to find Medical Leadership

When I first started thinking about Medical Leadership and Management (MLM) it was because I like to see things work. When anything doesn't work, or something is inefficient or I think a system could be designed to make life easier - I get pretty annoyed. So, being irritated in things is what got me interested in MLM, but now it seems that I spend quite a lot of time thinking about MLM just because it is so ubiquitous. Almost any day you spend in hospital will involve you witnessing MLM on an almost minute by minute basis - even if you don't notice it! Recently, I have being working on a number of projects in my spare time (mostly out of interest but partly to secure those elusive foundation program points), which involved reading quite a few journal articles on a number of subjects ranging from the "trauma care" to "gastric banding". What surprised me was the prevalence of phrases like "....teams need greater training in medical leadership to improve patient outcomes..." or "...medical education needs to include greater emphasis of soft skills such as communication, team work and team leadership.." The profession's views on MLM have obviously been developing for a while, within the literature and now some organisations are really taking this ethos to heart, but it is still not a universal phenomenon. So, I thought it would be interesting to post this blog and start documenting random places where MLM is mentioned. If anyone reading this finds any surprising mentions then please do paste the link to the article in the comments section.  
jacob matthews
over 3 years ago

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