Reviewing a Doctor's Performance Every Five Years

In the news recently an article caught my eye on the subject of appraisals for doctors in the UK every five years. The health secretary, Jeremy Hunt, says that the system hopes to address gaps in the care that doctors give their patients. If a doctor does not pass their appraisal, they would be prevented from practising until the issue is rectified. The change in the system has come as a result of years of discussion centered around maintaining high quality care given to patients, and making sure doctors perform consistently informed, compassionate and intelligent care. The secretary was keen to emphasise that the evaluation of doctors would be a process, and procedures would be put in place to rectify any deficiencies in care and address them early on.
The disadvantages put forward by this article and another (both links are below) are that there is already too much bureaucracy in the NHS and there are concerns that this system may just add to the piles of paperwork that already exist unnecessarily. However, there are also clear advantages to the new system, mainly that this focuses on a preventative measure and does not need a mistake before an investigation takes place, which is better for patients in a doctor's care. Overall, the system itself will be reviewed with time, and as Sir Bruce Keogh, medical director of the NHS put it, "Implementation will be quite difficult to begin with and I suspect it will be imperfect but it is better to start than to wait for perfection."


Article on BBC News: here
Article on The Telegraph: here
To find out more about the revalidation system: here
Image taken from: here

Thank you for reading!

The Inspirational Baroness Cox

Yesterday my school held a "Make a Difference Day", a day of seminars and fundraising activities for the whole school. The day was manic, there were pupils busking on the school site, endless bake sales, a coconut shy and a fun run. The causes that this was all for varied hugely in scope and purpose. From freedom of speech and saving the whales to providing earthquake relief, our eyes were opened to the many ways that we can make a difference.
One of the speeches that I watched was given by Baroness Cox, a truly amazing woman. Caroline Cox is a member of the House of Lords, a nurse, the founder and CEO of Humanitarian Aid Relief Trust (abbreviated to HART) and most importantly an all round wonderwoman. She told us with complete humility the work that HART does, providing humanitarian aid to any country that needs it. Run by a mere four people, the organisation focuses on countries that have largely been ignored or forgotten by the media of the world.
HART give aid to people that are oppressed or persecuted and, as it says on their website, they currently work on behalf of and in collaboration with local people in Armenia, Nagorno-Karabakh, Burma, India, Nigeria, Sudan, Timor Leste, Uganda and Egypt. A key part of their strategy, which I found to be innovative, is to use "local partners" in the countries that they help in order to achieve their goal. This means that they find the local people in charge, and give them a helping hand to start up hospitals, schools or housing in the area. I thought this strategy seemed very wise; rather than introducing a state of dependency on the organisation, this encourages local pride and cooperation, and gives a clear end point to the aid mission, but they can stay if needed.
Baroness Cox held the year group in awe as she told us about helicopter journeys fleeing heat-seeking missiles, jungle treks and earthquakes, but I found the most hard-hitting stories to be personal ones about individuals that she met.
One such recount was set in an area of South Sudan, ravaged by civil war that broke out in 2003, where tensions are still high as clashes between government forces, rebels and rival ethnic groups leave civilians in desperate need of medication, healthcare and a refuge from the violence. Baroness Cox told us how she was on standby while a both woman's legs needed to be amputated. In that region at that time, there were no analgesics on hand whatsoever. This surgery was done with no painkillers, only some alcohol that was administered to the patient once the surgery had begun. The woman survived the operation, but was in utter agony. On her next trip home, the Baroness described how she stockpiled as many of the strongest painkillers she could get her hands on, sometimes via illegal dealings. When she got them back to South Sudan, the villagers gratitude was immense. She said that the way she got them over the border was a story for another time...
Throughout her talk Baroness Cox described the wonderful people that she met and the hardships that they face. One village of people in Burma had their whole street burned to the ground, as all the houses were made of wood, and so had to trek across the jungle, fleeing the local soldiers that had been commanded to shoot on site any civilian in the area. Entire families carried everything they own on their backs, through dense jungle and unclean rivers. The jungle there, she told us, is not tropical; it is mountainous which means it is very cold at night. If they swam through a river, they could not light a fire to dry themselves because the smoke would be seen by soldiers, and so they walked sopping wet for miles and slept damp on the floor.
Baroness Cox told us about her journeys with them and with others, recounting stories of jungle medicine, hope and sadness. Pervading the talk however was a sense of optimism and motivation. At the end, questions were asked and one person asked her where she finds the motivation to do all the things that she does and has done for many years. She replied that when we see suffering, it evokes compassion, and this compassion gives us the fire behind our motivation. I find this notion to be incredibly inspiring. Baroness Cox ended her talk with the following idea: "I cannot do everything, but I cannot do nothing."
Wise words, from a truly inspiring woman.

References:

HART's Website: here
Image of Baroness Cox at the top of this post is taken from here

Orthopaedic Surgery: My First Experience

When the work experience coordinator said that I would be "in theatres" at a number of points during my week's work experience at the R.N.O.H, I was very excited indeed, but also nervous, as I had never watched surgery take place before.

Theatre implies a show, and what a show there was. The first drama was the very sight of the patient. When I walked in, all scrubbed up, the patient was asleep with general anesthetic and covered up with sterile blue sheets. He was entirely covered from view except for his left leg, which was being coated in yellow plastic, (I later learned from a nurse that this was to minimise skin shedding of the patient, that may get into the wound). Then came the first incision. It felt like my legs had gone from underneath me. The sheer shock of a person being cut up in front of me, albeit anesthetised, is a momentous one. Furthermore, as you look at the patient, in this case a small boy, you can't help but plead in your head that they'll leave him intact.

However, after the initial shock of the mechanics of the procedure, I soon calmed down. Even now, my first observations seem incredibly naive, in hindsight that is, but I've included them here for perspective. I was comforted by the conversations I had with the lovely anesthetists during the rest of the surgery. Having someone there to explain what is happening is immensely reassuring, and takes the nightmarish qualities out of the experience.

Likewise, seeing the measured cooperation and calmness of the team around me filled me with an equivalent composure, and I began to appreciate the complex surgery that was being undertaken in front of my eyes. Indeed the rest of the week followed and I saw a dozen surgeries, I am hugely grateful for the experience and became so accustomed to the blood and gore of that week that I am slightly concerned for my mental wellbeing as I doubt it is normal for a human being to be unperturbed by an entirely open leg, arm or hip of their fellow man. 

Regardless, I enjoyed the fascinating experience, and my first exposure to surgery.

Image source: http://ossmig.orthop.washington.edu/Portals/1/OR1.jpg

Open Doors Project

For the first week of the big summer holiday, while many of our age group were off frolicking on various exotic beaches, myself and a handful of other lower sixth students had voluntarily chosen to come into school at normal time. The reason was a community inclusive activity week for primary school children, called the Open Doors Project being held at my school. The sixth form volunteers were dubbed "student leaders" and for five days we helped out with all the activities that took place for the benefit of the children.

The children did a day each of arts-, music-, movement- and drama- related activities, to come together in a musical theatrical performance at the end of the week in front of the children's parents.
I was in the art group, which meant that each day a group of us sixth formers were left in charge of a dozen small children, who were let loose on art supplies and copious amounts of glitter. Essentially it was a week of arts and crafts with eight year olds, which proved to be great fun!

In the morning we briefed the children, in language and format that was easily accessible to them, which was the first challenge that we encountered; of course I did not start by using using complex language or a convoluted method, but it was difficult to gauge the level of maturity among the children, and we were very self conscious in case we patronised them, which would lose their respect and interest. In the end I just did what seemed natural, and sure enough the children seems to respond brilliantly. This was the first challenge, that of communicating in an effective way that was appropriate to their age group, but there were many more to come.

When the children got more used to each other, and they began to make friends from different schools, there was also the problem of keeping the children well behaved and working safely. It would have been okay to let them "run free" as it were, if not for the craft knives, hot glue guns and hot wax that was being used. This challenged me to think on my feet and assign jobs to children who for one reason or another, were acting up slightly. I quickly realised that everything runs better if each and every child is happy and busy, because if boredom sets in then they get restless.

I found it extremely rewarding working with the children, even if it was a little tiring, and at the end of each day I felt fulfilled in that I had helped a handful of children have a fun day.

Aside from the arts and crafts, the most rewarding part of the week was seeing (and playing a role in) their final performance. It was a fantastic show, and all the children were so happy before during and after, not to mention how proud the children's parents were of them. It was very rewarding to see the week's work come together so beautifully.

From the experience I learned how to teach and guide young children, and help them through challenges that they thought they could not do. Working in conjunction with both teachers and other student leaders has reinforced my sense of teamwork and gave me the opportunity to embrace a leadership role too.

All in all, it was well worth the week of summer, and I hope the children enjoyed their week!

St John Ambulance

Today I went on a St John Ambulance first aid course for all ages, so most of us had never been on a first aid course before. We started off with our instructor asking us about our expectation for the course and what we wanted to learn, which included procedures such as CPR (learn more here), dressing cuts and wounds and assessing emergency conditions. We then went through the basic theory and mindset behind acting in a an emergency, and then on to the first aid, which included practicals on each other and with specialist equipment.

I won't go into the specifics of the course, partly because I think that anyone who can definitely should go on a first aid course, and I can strongly recommend St John Ambulance (great staff, excellent facilities and comprehensive course) and secondly because it is much better to see it done and practice (on scarily lifelike dummies) than to read about it on a screen.

Having said that, I found that one of the most valuable things you take away from the session (aside from a pair of latex gloves and a face shield for CPR) is confidence. Just looking around the practice room, I noticed that one by one as a group we began to do the chest compressions with confidence, mean it when they shout out "I need you to call an ambulance immediately!" and wrap the bandages with diligence. As our instructor said, just simple knowledge can save lives. 

I enjoyed learning about the first aid so much, not to mention the feeling of reassurance that you have a bit of concrete knowledge in the area, that I'm looking into taking a longer course that covers more scenarios, even considering volunteering with them, and I'll keep you posted. If anyone is interested, I can definitely recommend, even if the dummies are a bit creepy!

Thank you for reading!

Medical Ethics: Weighing Up the Pillars

At school we were very fortunate to hear a talk on medical ethics by Dr Mona Kooner, a lovely lady who has been a GP for a number of years. Excitingly, her new book on getting into medical school is released next month, and if she writes as clearly and eloquently as she speaks, then I can already recommend it.
Today's talk focused on Medical ethics, and by extension the extrapolation of these ethics for the BMAT exam (Biomedical Admissions Test for entry into some UK med schools) and medical school interviews. Dr Kooner introduced us to the GMC (General Medical Council, learn more here) publication "Duties of a Doctor", a guidebook of sorts that sets down the responsibilities that doctors hold. It is, in Dr Kooner's view, dry and pious; dissimilar to the varied and fascinating subject of medical ethics that she spoke about.
We learned that the four pillars of medical ethics are as follows:

1. Autonomy - the patients right of control over their own body and lifestyle.
2. Beneficence - only doing what is good for the patient.
3. Non-maleficence - not harming the patient. 
4. Justice - being fair or reasonable.

Essentially, all of these "pillars" have to be considered before a difficult decision is made, and in the BMAT exam and medical school interview, you have to prove that as a potential medical student you can do so.
So, how do they work in practice? Let us use the example that Dr Kooner used. Consider the following controversial statement:
"People that do not make an effort to quit smoking should not have unlimited access to the free healthcare that the NHS provides."

When one is sitting in a dingy exam hall, or sweating in front of a panel of medical school admissions officers, it can be hard to organise the scattered thoughts that surface when faced with such a dilemma.

As I am prone to on-the-spot nerves myself, I can see how it is times like these wherein the pillars of medical ethics would become very useful indeed. Taking our first problem, we can see that while justice falls on one side of the weighing scales, we can infer that beneficence, non-maleficence and autonomy fall on the other.

They break down like so:

• Justice - as they continue to partake in self-harming behaviour without attempting to stop, it is not fair that smokers use up precious medical resources that could be used on non-smokers.

However, this is the only one of the pillars that falls in favour of the statement, as we will see.

• Autonomy: the smokers have every right to smoke if they want to, and have no obligation to attempt to quit.

• Non-maleficence: by not providing treatment to a potentially ill  patient, you are directly harming them.

• Beneficence: similarly, if you allow the smokers full access to the NHS then you are helping them.

In this way, we can break the potentially baffling ethical dilemma into manageable chunks which allows a concrete thinking process, without the diluted, what-feels-right leanings.

In fact on that note, Dr Kooner made it very clear that whether it's in the BMAT exam, interview or your time as a doctor, your own beliefs should never affect your decision, and you have to be understanding, non-judgmental and unbiased when making decisions about patients and their care. Just another reason that I am falling in love with the field of Medicine; it is a level playing field where care comes first, which is in my opinion exactly how it should be.

Thank you for reading!

Out of Sight, Out of Mind: New Smoking Display Ban

Figure 6.1: Smoking Prevalence and Lung Cancer Incidence, by Sex, Great Britain, 1948-2010

Today on BBC News I read an article about how cigarette displays are to be moved and placed below counters in large shops and supermarkets. The move will happen in England this year, cigarette displays will be banned in shops that are over 280 square metres, with the ban extending to smaller outlets in 2015.

The thinking behind the move is that by not having the cigarettes readily visible to the public, particularly young people under 18, it will discourage potential young smokers from taking up the unbelievably unhealthy habit. Furthermore, it is hoped that the ban will help those smokers who are trying to quit by removing the temptation from weekly shopping trips. Harrowing figures from the website say that a fifth of adults in the UK smoke - a figure which has remained steady in recent years after decades of rapid falls. At the beginning of this post I included a graph from the Cancer Research UK website showing the smoking prevalence trends in Great Britain by sex, from which we can see that while the number of adult smokers had rapidly declined since around 1974, the rate of this decline has slowed in recent years. Of course, this graph only shows adult smokers, and does not take into account the number of young people who take up smoking every year.

From the Cancer Research UK website, we can learn the following about child smokers:


"It is illegal to sell any tobacco product to under 18s in the UK. However, while less than 1% of 11 and 12-year old children smoke, by the age of 15 years, 12% of children in England report being regular smokers (usually smoke at least one cigarette per week). (23) According to these figures, the Department of Health has met its 2011 target of reducing smoking among 15-year-olds in England to 12% .(52) However, there is evidence that actual smoking rates among 15-year olds may be higher than reported, based on measurements of cotinine in saliva, with 21% of 15-year old boys and 19% of 15-year old girls having cotinine levels indicative of active smoking. (24) "

If you're interested, the titles of papers they used to obtain the figures are linked to the numbers in parentheses in the above paragraph.

In 2008, marketing professors Janet Hoek, Phillip Gendall and Jordan Louviere presented research at the Australia and New Zealand Marketing Academy Conference that found:

“tobacco brand imagery functions via respondent conditioning, where brand names, colours and other imagery become paired with psychological and emotional attributes. These peripheral cues act as heuristics (definition here) that do not require systematic processing, but are implicitly relied on by smokers to move from their actual self to their desired self.”

In a nutshell, Jean King, of charity Cancer Research UK, said the ban would help stop children who are attracted to brightly coloured tobacco packaging from taking up smoking but further action was still needed."Of course we want to see the pack branding taken away as well. This is not a normal consumer product, it kills people. We want to protect the next generation of children," she said.

However, while I have presented views that support the ban, there is controversy surrounding the murky waters of suggestive advertising, and there are opinions to the contrary. For example, Andrew Opie, from the British Retail Consortium, said it was wrong to believe the legislation would have a major effect on young people and it was supermarkets and other shops which were bearing the brunt of the costs needed to comply with the ban. He said: "Children are more likely to smoke when they're in a household where parents smoke and also they tend to get their cigarettes from either parents, or older peers, not directly from supermarkets."

My own view is that while it is people's own choice to begin smoking, any move from the government that discourages the habit, or even makes it less obvious on an everyday level, should be wholeheartedly supported. It is also my view that to some extent the tobacco companies actively target the young, which I do not agree with on a moral level. I believe we need to do whatever we can to protect vulnerable and impressionable young people from the marketing and peer-induced "glamour" or "normality" of starting smoking, to prevent the tragic health problems that it brings.

As you can tell, the news article prompted me to do some of my own research into the area; I will be interested to see if the move has an impact upon people on a personal level, and prospective trends to come.

Thank you for reading!

References:

http://info.cancerresearchuk.org/cancerstats/types/lung/smoking/lung-cancer-and-smoking-statistics
http://www.bbc.co.uk/news/health-17626133
http://theconversation.edu.au/plain-cigarette-packaging-will-change-smoking-slowly-737