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?