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

Feelings of a cancer patient.

 I cannot begin to imagine what kind of emotional and physical strain that the brave people I met last week go through on a daily basis when battling with their respective cancers. However, after talking for a while with a couple of patients, nurses and the doctors that know them about their experiences, I have begun to grasp some of the common hardships that are felt between patients with vastly different cancer types. Understandably some of them feel vulnerable, some feel lonely, some feel helpless. Some of them feel positive, others do not. The transition between an active, independent lifestyle to a nearly bed-bound state for many of the in patients can be upsetting. Even something as simple as washing yourself becomes a debacle when you need a stranger to scrub you down, which, although the nurses are exceptionally caring and understanding in their approach, it is understandable that some patients found it demeaning. It is something so simple that I had previously taken for granted, a registrar pointed out to me as we were doing a ward round that most people haven't been washed by someone else since they were a baby, and to return to such a state after a lifetime is often demoralising.

The registrar also voiced the fact that when you're in hospital, a doctor will walk in on a patient using the commode and apologise, only to have the patient, according to the registrar, say "It's alright, come on in." In everyday life for most of us this would not happen. Of course, the doctor-patient professional relationship is in place for a reason, as the doctors and nurses alike need to be able to asses the wellbeing of the patient and provide treatment, and this is often only possible by doctor and patient shelving their everyday attitudes regarding personal care, and proceeding with the best patient care possible.

Furthermore, I received a first hand account of how a patient can feel objectified. An in patient, who we'll call Mr Cox* told us how he felt as if he has become a list of symptoms to his doctor. Not all the time, he was keen to stress, but sometimes, and it was understandably very draining. The "endless" questioning he was subjected to about his final wishes, and his condition, Mr Cox told us, made him very depressed. Even though the doctors were asking ultimately for his benefit, he did not like repeating himself up to five times a day, particularly as he could rarely report  back any good news.

Despite this, during our conversation Mr Cox was quietly optimistic and good-humoured, even though he had decided to give up on the chemotherapy and live his life at home from now on, and he was looking forward to seeing his dogs every morning.

The moving conversation that we had with Mr Cox showed me how ignorant I was of what strains the patients are subjected to, completely aside from the vicious effects of the chemotherapy. It broke my heart to hear it, but I believe that Mr Cox is one of the bravest individuals I have ever met, I felt humbled and privileged to speak with such an inspiring man.

*All names on this blog have been changed to respect patient confidentiality.

I wish him all the best for the future, thank you for reading.

Be a dentist.

In a break from ward rounds, a group of the SHOs, the other two students from my school and I found ourselves talking about dentistry, and how it compares to medicine. Out of the five SHOs in the room, when asked, only three would choose to do medicine if they had their life again. At first glance, this seems like good odds as it is the majority, but I find this a tad disconcerting. From my point of view, all of these individuals are, in essence, living the dream. They got into medical school and came out the other side, they're well adjusted to and seemingly happy with a job that I aspire to work my way towards, and yet only just over half would do it again? Should I be concerned about this fact?

When my friend asked whether he should do medicine or dentistry, the response of "do dentistry" overwhelmed that of medicine, with four of the SHOs discouraging him from their own profession! Of course, the scientific side of me is having a field day, as this is by no means a reliable study, simply a random sample of the professionals that were in the room at that time, and is by nobody's standards a conclusive survey. Nevertheless, the conversation was an interesting one.

Their reasons were as follows, and though the final verdict of "I would rather not have been a doctor" was not shared by all, everyone agreed on the reasons that the dispassionate (disillusioned?) two put forward. Firstly, that there was no such thing as a nine-to-five job in medicine; one was nearly always working.  In the first couple of years, you are a "dog's body" as one SHO put it.

Another disadvantage of being a doctor is you get moved around every four to six months, although refreshing, this can lead to leaving behind a whole set of friends and maybe even living spaces, if you're moving somewhere far away, a couple of times a year!

Now, of course, medicine is a vocation and I can definitely see that, but something else that came up in the open conversation in that relaxed afternoon in the office is the number of friends' gatherings, parties, weddings and even sleep that every SHO had missed out on. One, let's call her Lucy, couldn't even confirm whether or not she could go to her best friend's wedding, as she had not been told whether she was "on-call" that evening. They stressed that although it isn't often required per se, you have to stay on some evenings simply because any doctor worth their salt can't just leave one of their patients when they are needed, for whatever reason. From my own limited experience, I can completely understand this, each day of work experience at the Marsden was scheduled for us to leave at five, but every evening we stayed on for a couple of hours longer - and we didn't have any responsibility for the patients, let alone any skills that we could utilise, we stayed only out of sheer interest in their well being.

They SHOs all agreed, however, that under no circumstances would you be bored at work as a doctor. On a fundamental level, you are using your skills and dedication in a team of people that are striving to improve as many lives as possible, and relieve human suffering, and I don't think you can ever escape that intrinsically admirable fact, and it is definitely one of the most compelling reasons I have for wanting to be a doctor.

So where to go from here? I would like to talk to some more doctors about how they find the balance in their job, and learn more so that I can evaluate whether this profession is right for me.

Personally I am not interested in dentistry, and I mean no disrespect to dentists when I relay this to you. But the response that they gave my friend who is considering it was summarised in the following choice phrase "if you want to be bored and rich, be a dentist." Make of that what you will...

Finally, I am very grateful to the honesty of those lovely SHOs if they're reading, it's not easy to admit if you regret something, but I am incredibly thankful that they were so blunt about what they really thought about being doctors. This way, if I do decide to enter into this "fresh hell", I can at least go in ready, with my eyes wide open.

What would you do?

Patients have, quite rightly, a lot of choice in their treatment and their view is generally held above everyone else's. However, I've noticed in my brief time at the hospital that, quite understandably, the patients just want the safest-sounding option for their treatment. Although the facts and figures help in their decision making, ultimately to some patients they are just numbers, and they rely on their doctor for some straight talking advice. All they want to know is, if it were you doctor, what would you do?

The MDT Meeting

In my time at the Marsden I sat in three MDT meetings, and they were referred to at least four or five times a day aside from this. From this you can see how integral these meetings are to the daily workings of the hospital.

The "MDT" stands for "Multi-Disciplinary Team" meeting, and essentially it is where everyone that is associated with a patient's care comes together to discuss treatment, review objectives and eat a few biscuits.

Each patient under a consultant is talked about in depth, their latest blood count, their CT (computed tomography - learn more here) scans, their progress through treatment and their general well being is covered.  It was here that I really got a feel for how integral teamwork is to successful patient care. The amalgamation of professor, nurses, registrars, research nurses and other key team members was impressive to say the least, because for each patient a different opinion is heard, and in this way all the information is present at the same time, leading to a streamlined system of care.

However, later in the week one of the registrars and I were seeing a patient (I say seeing, what I mean is that the registrar was seeing the patient, I was mostly nodding and accidentally getting under people's feet). This out patient, I'm calling her Mrs Williams*,  had been discussed in that morning's meeting; she had pancreatic cancer, and had just finished her third cycle. In the MDT meeting it was concluded that she was responding so well, from a medical point of view, that her treatment would be extended for another one and a bit cycles. This all sounded very promising, but later that day I was there when we saw Mrs Williams in clinic (learn more here), and she told us about the side effects she was experiencing. Which I learned vary between chemo treatments, as each plan is tailored for the patient, sometimes different drugs are used, or some are left out all together - hence the diverse side effects. Mrs Williams was alarmed by the size that her ankles had swelled to as a result of the chemo, and she was in pain. The registrar, too, was concerned that there may be clotting in the left leg that was much bigger than the right, but both looked painfully enlarged (similar to in this photo), with the skin stretched uncomfortably. Furthermore, she was suffering from constipation, excess urine and nausea, all very uncomfortable conditions. An ultrasound was proposed by the registrar to make sure there were no clots in the left leg which could lead to more problems. This lady and her husband were frightened of the seemingly alarming side effects, to the point where it was only reluctantly that they agreed to carry on with more cycles of the chemo. The registrar prescribed a cocktail of drugs to deal with the side effects; which for Mrs Williams means another set of pills to take every morning.

Afterwards, the registrar was telling me that there is a major flaw in the MDT meeting set up, because discussing something in a meeting in a boardroom with colleagues and biscuits is very different to seeing the patient right in front of you with hugely swollen ankles who can barely walk. There isn't much that can be done about the problem, but it's there.

Thank you for reading, I wish the brave Mrs Williams a comfortable and speedy recovery.


*All names in my blog have been changed to respect patient confidentiality.

A Med Student's View

...Of the Royal Marsden, Oncology and Medicine

Before the first day of my work experience at the Marsden I found myself in the queue for the staff bus that goes directly to the Sutton site. Now, I'm not certain that I was allowed to use this bus, but in the queue I made friends with two doctors that kindly said they would vouch for me if the suitability of my taking the bus was questioned. This was very generous of them, because I'm not fond of red buses and even if I were, I didn't have the faintest idea of where to find one.

Safe in my seat, I began talking with a third year junior doctor, on his elective (learn more here) from Germany. We talked about oncology, and his experience so far of medicine. He had been at the Marsden for eight weeks, and I asked him what he thought of the Hospital. Like so many of the people I would talk to that week, he told me how friendly it was, how all the staff were happy to be there and how generous everyone had been with their time when showing him the ropes of a modern cancer hospital.

He mentioned also that he had worked in an A&E (Accident and Emergency Department - learn more here) in Germany, when he saw the book I was reading (In Stitches by Dr Nick Edwards, a cracking read, but more on that later). A&E is, he told me, very intense, but in his opinion it simply does not compare to Oncology. Where A&E gives you the thrill of emergency, often instantly life-saving medicine, oncology provides a deeper, more real experience about what it means to care for and treat a patient, as you stick with them, build up a repertoire, and see their story right until the end, in most cases. Granted, he said, it is draining and not a job for everyone, but on an emotional level it is an incredibly gratifying job, and he would not trade it for the "drama" that you experience in the A&E department. I wonder if many other medical students rotating between areas of medicine would agree.

It was very interesting to hear his views, as he has had a far more extensive taste of what different areas of medicine are really like, and I was glad that I had taken the staff bus, even if it did get me a few odd looks.

Thanks for reading!

Taking Patient Histories

We were shown how the registrars (who are they? learn more here), the Prof and other doctors deal with patients that have just been admitted to the hospital, usually by their GP. Most of the people we saw had at this point been already diagnosed with cancer. Although this is a sombre setting, for the oncologists it is part of their daily routine, and meeting patients for the first time in clinic is often refreshing, because every person, and unfortunately every cancer, is unique.
Seeing the registrar collect a patient history was mesmerizing to listen to. Though I'm sure it requires great practice, she made it look as effortless and breezy as a coffee morning chat. As we said our goodbyes to the patient, the doctor showed me her notes: they were detailed, clear and concise, yet she never even broke eye contact with the patient for more than a few seconds! Witchcraft!
I've noticed that communication is vital skill in Medicine, and although this would seem obvious I never really understood it until shadowing the four different doctors that I did today. Each had a different approach to understanding their patients' concerns, but all of them were reassuring, clear and genial in their address of the patient. Of course, the patients deserve nothing less, but I can more clearly understand why medical interviews for universities place so much emphasis on interview. It's a people person job, and listening is key.


Thanks for reading!
 

Work Experience First Impressions

Today I undertook my first day of work experience shadowing and observing registrars, nurses and consultants at the Royal Marsden (Sutton) and I was scribbling down notes all day, twenty pages worth in fact! I planned to do a blog post about all my experiences that I've had today, but rather than write what would be a rather mammoth post, I've instead decided to break it down into digestible, hopefully even interesting, accounts of my glimpse into the fascinating and varied world of modern medicine.

For now though, just three of my first impressions of one of the most state of the art, welcoming and genuinely friendly hospital environments that I've ever found myself in: there is a tangibly strong sense of community at the Marsden, the staff are exceptionally talented and hardworking at what they do, and the patients definitely appreciate the excellent care that the hospital provides.

More to come, thank you for reading!

Can a Daily Dose of Aspirin Reduce Cancer Risk?

Skeletal Structure of Aspirin, featuring skeletal representations of the benzene ring, double bonds and OH group.

Today the front page of the BBC News' Health section proclaimed that "Daily dose of aspirin can prevent or even treat cancer". Along with many others I'm sure, I excitedly began reading the article, as surely anything even suggesting a "cure" for cancer is very engrossing news indeed, even in early research stages. I recommend reading the article in full, and if you're interested take a look over the three new research papers published by the medical journal The Lancet. Aspirin (acetylsalicylic acid) has been used for many years as a painkiller. It can be antipyretic (reduces fever), anti-inflammatory (reduces inflammation) and analgesic (relieves pain). However leading the headline of the BBC article is, it does not hide the harmful side effects (which you can see in full here) of taking aspirin on a regular basis, which include internal bleeding.

It seems that the crucial advice one can take from this news is that whoever is thinking of taking a daily aspirin should talk it over with their GP due to the risk of the side effects. Likewise, critics of the study have pointed out that some of the doses given in the study were much higher than the 75mg dose typically given in the UK. Also, some very large US studies looking at aspirin use were not included in the analysis. The researchers acknowledge both of these points in their published papers.

While I too am excited by the prospect of the new evidence and more studies to follow, I hope that the article on the front page of the BBC News Health section does not prompt anyone to rush out to buy and self-administer daily aspirin without first consulting their GP and talking it over with the health professional who knows them best.

Thank you for reading!

Do not resus?

My view on an article published in the Student BMJ

"Making Decisions about your Death"

Should a doctor presented with a 22 year old unconscious woman with a tattoo that reads 'Do not resuscitate' heed the order that has been inked onto her skin?
On some level, I believe they should not help the patient, it says clearly on her body that she had made this decision about the way she wanted to die, and cared so much that it be followed she had it tattooed onto her skin in case this circumstance arose.
However, a much stronger part of me argues that as a physician one simply cannot take the risk of letting a patient die if that is not exactly what they wanted in such a life-threatening situation. What they may have wanted when planning a tattoo may not cohere with their wishes in the emergency room.
Would the situation be different if the woman was 92 rather than 22? Maybe. From a legal perspective, the three letter phrase is not binding, as the article points out. Considering the situation rationally, in my opinion there is only one course of action that can be taken: to give the patient the best chance at life that a doctor could provide, and the strongest incentive for this argument is beyond the legal and social expectations, it is simply that the risk of letting a patient die who had wanted to live is far too grave a risk.

If you're interested you can read the full article in the Student British Medical Journal
2012;20;e658 Or read it here.

Thank you for reading.

Talking About Cancer

Today at school our year group listened to a talk on cancer, given by a representative from Macmillan Cancer Support, which is a UK-based charity that strives to improve the lives of people living with cancer (link to their website is below). It was an informative and hard-hitting talk that elaborated upon what knowledge we already had of cancer and the symptoms associated with it. Primarily the talk focused upon emphasizing the need for people to know their bodies well and "know what's normal" biologically. This included demonstrations of checking for lumps in breasts and testicles, where an uncannily lifelike collection props was used by the speaker.

The most valuable piece of information that I took from the talk was that cancer affects everyone, whether they are diagnosed with cancer or they know a loved one who has been. I undertook some personal research and found that in 2008, it was estimated that there are just over two million people living with or beyond cancer in the UK who had previously been diagnosed, and this is predicted to rise by more than 3% a year. These figures were taken from Cancer Research UK, (link also below).
I was heartened to learn about the groundbreaking work that Macmillan does, and other charities like them, and I was touched by the sincerity and bravery of all the survivors of cancer that the charity represents. I recommend taking a look at their page, supporting their cause and getting more people talking about cancer.




http://www.macmillan.org.uk/Home.aspx
http://info.cancerresearchuk.org/cancerstats/incidence/

Dear Reader

Very happy to be starting this little blog, and hope to keep readers updated with my progress as a potential Medical applicant. I will be writing opinion pieces, referencing medical journals, recounting my experiences and posting items of general interest, and I promise I'll try my best to keep my posts succinct, regular and maybe even interesting! If you have any questions about anything I write, just comment and I'll get back to you as fast as possible!

Thank you so much for stopping by, 

Best wishes, Annabel B.