May 2011

The voice of London’s Medical Students

the medicalstudent

To conference and ceilidhJohn Hardie

On 1st and 2nd April, medical students from across the country gathered in Edinburgh for the BMA Medical Stu-­dents’ conference, to set Medical Stu-­dents’ Committee policy. Over 50 mo-­tions were proposed, debated and voted upon by the delegates over the course of two days. Key speeches were giv-­en by Karin Pursehouse, MSC chair, Hamish Meldrum, BMA chair, and Ni-­all Dickson, Chief Executive and Reg-­istrar of the General Medical Council.London medical schools were

strongly represented at the confer-­ence, proposing motions on Student Fi-­nance, the UK foundation programme, Intercalated degrees and electives.Some respite from the serious po-­

litical debate was provided in the form

of the gala-­dinner and appropriately, being in Scotland’s capital, a ceilidh. Johann Malawana, registrar in gynae-­cology, doctor on the GMC and former Bart’s boy, set the tone for the even-­ing. By his own admittance, his risqué after-­dinner speech could be judged successful if it had “offended a good proportion” of those at the conference.The morning after the night be-­

fore, the Scottish Medical Students Committee’s suggestion that “doc-­tors and medical students should be role models for society” was met with some derision from the floor. The Medical Students’ Committee is

comprised entirely of medical students, including elected representatives from medical schools and a core executive committee. The MSC’s work involves negotiating with the Government, GMC, UKFPO and the Medical Schools

Council to support student issues. Karin Pursehouse, MSC chair,

introduced the overall priority is-­sues for the committee over the com-­ing year -­ with fees of £9000 per year confirmed by many universities, local authorities freezing their maximum student loan, and banks withdraw-­ing low-­interest professional develop-­ment loans, students could be landed with an excess of £70 000 of debt dur-­ing their medical degrees. Consider-­ing these changes, widening access to medicine was highlighted as an im-­portant issue, particularly the provi-­sion of sufficient student bursaries. Pursehouse also noted that long-­

term workforce planning was vital in order to prevent graduates from UK medical courses being left with-­out jobs, especially as in 2010 there was an oversubscription of 184 plac-­

es to the UK foundation programme. GKT’s motion to lobby relevant de-­

partments to increase student loans in line with inflation was carried. They recognised that the freeze in loans and grants for living costs from Sep-­tember 2011 would represent a cut in real terms for students, with the in-­flation of the Consumer Price Index set to remain at its current high rate.The MSC conference did not vote

in confidence of health and social care white paper, unlike the BMA Special Representatives Meeting earlier in the year, which did not outwardly reject the proposals. The conference raised concerns that the white paper is a con-­tinuation of a recent movement towards privatisation in the UK health service. The foundation program was an-­

other important topic of concern. (cont’d on page 2)

Filthy exploits - an exhi-

bition of dirt

Page 14

iHave a dream - the pros

and cons of smartphones

Page 12

Kings’ slander - review of

the UH farce

Page 3

Aiming high - an explora-

tion of exam doping

Page 6

Travel pullout included for summer inspiration

May 2011 medicalstudent2

NewsNews Editor: Ken Wu

news@medical-student.co.uk

Things have been alive and kicking as always down at GKT. Though it was not the beauty parade implied in the title, ‘GKT’s Got Talent’ served up a plethora of magnificent performanc-­es ranging from singing and dancing to sketch shows and impressions. The third years then dusted down their dinner jackets and celebrated mak-­ing it halfway at the Grange Hotel, St Paul’s. If this was anything to go by, the upcoming GKT Summer Ball with special guest DJs the Scratch Perverts spinning the decks is going to be an absolute hoot! This brings me to the UH comedy revue: having been told that the compere was going to be “the one from the Amateur Transplants” we felt cheated when we arrived to see Adam Kay rather than his more esteemed colleague Suman Biswas on

stage. Rather than have the good grace to do the London Underground song he presided over this mockery of an event. Other than the obligatory heck-­les from the crowd nothing funny was delivered until GKT served up a side-­splitting performance to end the show. However, I must congratulate fellow President and personal friend Luke Turner for winning the cup. Finally I would like to wish all our final years the best of luck for their upcoming ex-­aminations, I’m sure you’ll ace them! .

Hari Haran

GKT Medsoc President

It’s been a fairly quiet month for us here at BL;; with various years off on “spring break” at various different times (nice one time table organisers) it seems like things have come to a bit of a stumbling halt after the mammoth week of Ragging! I hope that those in the pre-­clinical years are finding revi-­sion bearable. This time of year is also the time of project/dissertation com-­pletion for our intercalating students so it seems that Whitechapel library is seeing more action than the Griffinn! We did have the Association din-­

ner in the midst of all the work;; a to-­tal success for our VPs Megan Brocken and Jenna Kelly, whose organisation allowed 200 slightly inebriated medi-­cal students and staff to enjoy a fan-­tastic three-­course dinner and award ceremony in the Great Hall at Barts. Congratulations to all clubs, socie-­ties and individuals who were nomi-­

nated/won an award on the night!Unfortunately, the beloved Griffinn

will shortly be closing. However, after years of lobbying and a lot of hard work we are finally getting the long awaited refurbishment we so desperately need. It’ll be a few months before it’s reopened in all its brand spanking new glory.Lastly, our summer ball is set to

be amazing and tickets have already gone on sale. It includes unlimited goes on attractions (someone say la-­ser quest?) and food. Rumour has it some familiar lecturing faces will be present and extremely vulnerable to an unlimited supply of cream pies .

Laura Brenner

BL President

What a term, packed full of events for both the SU and the entire uni-­versity. Mixed Hockey won a shield at the Wesleyan tournament and St George’s Revue won the coveted UH Moira Stewart cup! Despite the offen-­sive heckles from an inebriated ICSM president, we trounced GKT in the fi-­nal vote thanks to incredible support from not only SGUL but a few other friendly medical schools as well. We also witnessed the union’s first ever Go Green Week and Wellness Week at SGUL, I hope they will become a regular feature in the SGUL calendar. The sabbaticals attended the annual BMA conference where we debated the various issues facing medical students

(namely financial). We also attended the NUS National Conference where both RUMS and SGUL had the pleas-­ure of representing the medical student vote. With a future of uncertain fund-­ing for medical schools and rising tui-­tion fees, both the BMA and NUS have set a clear focus on widening access to Higher Education. It is so important that all student unions across the coun-­try remain engaged in this process. I hope you all had a good Easter .

Luke Turner

SGUL President

Editor-in-ChiefJohn Hardie on the last Medicalstudent of the year

Take a good look at the beau-­tiful smiling faces printed on this page. This is the last chance you have to gaze at

the magnificent forms of your student union presidents before the bring young hopefuls arrive. They’ve fought off Dai-­ly Mail reporters with their bare hands, pleaded on their knees with the British Transport Police to “let my students go” during RAG week, and attempted to undercut each other repeatedly with mudslinging matches in MS newspaper. For the last issue of the aca-­

demic year, this column is a lit-­tle on the serious side. However, as we approach committee changeo-­vers and wider political change, it seems appropriate to reflect a little.As you might have noticed, even if

you’ve been keeping your eyes closed as of late, we’re going through the most important changes in the his-­tory of Britain’s health service since 1948. In addition, higher education is receiving its greatest shakeup since

the previous Labour government’s plans. Students, on the other hand, haven’t really changed since 1948 on the whole -­ apathy is pandemic when it comes to expressing opinion. The thrill of the protests was enough

to bring students out onto the streets. As useful as demonstrations are as catalysts for persuading authorities to take notice, they don’t show a reasoned desire or expression for change. Medi-­cal students of today will be those most affected by the changes. Yes, there are all those innervations to learn for anat-­omy exams, and that beer won’t drink itself on a Wednesday evening but we also have the time and opportunities to express our opinion and lead debate.Go and speak to you MP, or write

to them using the online system www.writetothem.com. Get involved in the medical trade union, the BMA, by standing as a medical students com-­mittee representative. Write into your newspaper, whether it be na-­tional, local, student or otherwise.

Closer to home, make sure to vote in your student union elections, get in-­volved in societies, and tell your aca-­demic committees what you think and what you would like to see changed.Your trusty student rag, the Medi-­

cal Student newspaper, is looking for comment and features editors, as well as writers. To get involved in any ca-­pacity, simply contact editor@medi-­cal-­student.co.uk. We’ll be returning in October. What will you do with-­out us? Enjoy the summer months .

Find us on Facebook and Twitter@msnewspapermedicalstudent newspaper

Editor-in-chief: John Hardie Assisstant editor: Amrutha Sridhar News editor: Ken Wu Features

editor: Neha Pathak Comment editor: Sarah Pape Culture editor: Robyn Jacobs Doctors’ Mess

editor: Abe Thomas Sports editor: John Jeffery Treasurer: Alexander Cowan-Sanluis Sub-editors:

Martha Martin, Giada Azzopardi, Lucia Bianchi, Kiranjeet Gill, Hayley Stewart, Bibek Das Image

editors: Chetan Khatri, Purvi Patel Illustrator: Bridie Hernon Copy editor: Rahul Ravindran

Distributing officer: Sevgi Kozakli

Contact us by emailing

editor@medical-student.co.uk

or visit our website at www.

medical-student.co.uk

themedicalstudent

(cont’d from front page) London stu-­dents proposed that the BMA should call upon UKFPO to include aspects of the white-­space questions in the future application process. The motion car-­ried with a significant majority. The MSC claim they have already been lobbying UKFPO, but to little effect. The higher administration costs for the white space questions in comparison to computer-­marked multiple-­choice questions is likely to be a large factor in UKFPO’s decision. However, Impe-­rial’s call upon the BMA to lobby the Medical Schools Council to ensure that additional degrees are still given credit in the foundation programme applica-­tion process was rejected. A BSc, or

any other additional degree courses are not likely be taken into account with the allocation of points to the applicant. Bart’s proposed that medical schools

should instate a maximum quota for the number of graduates on the undergrad-­uate course “given that it is primarily for undergraduates”. They withdrew their motion with some discomfiture before it came to debate, after it became apparent that their proposal would work against their own school, which takes a majority quota of graduate students. In his keynote speech, Niall Dick-­

son, Chief Executive and Registrar of the GMC, said “quality must be the organizing principle of the fu-­ture NHS.” He noted the major chal-­

lenges for future medical practition-­ers -­ The ageing population will bring about a demographic with a great-­er array of long-­term co-­morbities for the health service to cope with. Dickson controversially affirmed

that he is strongly in favour of regis-­tering medical students with the GMC as soon as they embark upon a medical degree. He claimed that this would al-­low students to establish a relationship with the council early in their careers, reinforce professional standards, and allow greater effectiveness in monitor-­ing Fitness to Practice. This tapped into fears that students would be subject to even closer observation during their education than is currently the case .

medicalstudent May 2011

News3

Alex Nesbitt

RUMS MSO

If one more person says “so is every-­thing winding down now?” to me, my head will probably explode. We have been extremely busy over the last month at ICSMSU, and things show no sign of slowing down any time soon.Our sports teams continue to spark,

shank and sometimes even merk our London rivals, with ICSM Hockey winning the UH Cup by defeating the infidels at Barts, and our Netball team being crowned BUCS champions. This has been a highly eventful year full of numerous highs and a few lows. It has seen us being mentioned in the national press for having the highest scoring fi-­nal years and the best drinkers in the country. It has also seen our Union be-­ing threatened with censure from the Imperial College Union council, our sports teams destroying all before them,

our societies putting on professional-­standard shows, concerts and confer-­ences, our Freshers raising thousands of pounds for charity, and our bar being refurbished and having one of the most profitable years (so far!) for centuries.We will still be working hard for

our students next term. Make sure you don’t miss the bops, the end of exam barbecues, the inspirational talk by Professor David Nutt, and of course, the highlight of the social calendar, the fantastic Summer Ball, to be held this year in the Grand Connaught Rooms .

Anil Chopra

ULU Medgroup Chair

David Smith

ICSM President

On Friday 15th April, Imperi-­al College played host to the UH Revue, for the first time in living memory. It was a

night of comedy and competition that eventually saw St George’s go home with the coveted Moira Stewart cup.As per the rules of the competi-­

tion, each school was given twenty minutes to perform sketches, songs, and videos with the aim of being the funniest group of the night. The event was held at the Great Hall in Imperial, which was packed full to capacity. As if playing to an audience of 700 people wasn’t hard enough, this was made, as per tradition, dramatically more diffi-­cult by the raucous heckling and jeer-­ing from rival schools in the audience.ICSM’s own son, Adam Kay,

compered the evening, warming up the crowd (perhaps a redundant task) with a medley of songs from the Amateur Transplants as well as covering the change-­over between medical schools. Despite being an Imperial alumnus, he oversaw the au-­dience clap-­o-­meter with utter fair-­ness (the non-­partisan bastard!).Securing their first win in six years,

St George’s celebrated their victory in FiveSixEight, Imperial College’s stu-­dent union, where they were joined by everyone else. Despite being in the mid-­dle of the Easter Break, the attendence at the union was very good, with sev-­eral draught taps at the bar running dry. Anil Chopra, the ULU Medgroup chair was anstonished when of one of IC Un-­ion steward said: “I’m sorry I can’t let you in. There are too many girls in here -­ we just don’t know what to do!”One performer in the Revue de-­

scribed it beforehand as a “blood-­sport.” This proved amazingly ap-­propriate as most acts had to struggle through fierce heckling of no great

St George’s win UH Revue

Rhys Davies on an evening of sketches, heckline and an arm-wrestle

wit. In fact RUMS had to cut short one of their sketches rather than limp through the abuse. Actors in their later sketches tried to regain control, but had little success. Commanding a thick swathe of seats near the front of the hall, GKT were particularly merci-­less in their audience ‘participation’.Despite this, the competition was

fierce and closely fought. After all five schools had performed, the traditional clap-­o-­meter put George’s, ICSM and GKT ahead. Pioneering the AV flavour of democracy, Adam Kay called on the Bart’s and RUMS audience members to choose their winner. This narrowed it down to George’s and GKT. The stale-­

mate could only be truly decided in one fashion – arm wrestle. Each school fielded a candidate and it looked like the outcome of the UH Revue would rest on a moment of superior upper body strength. It was then pointed out that both lads were from GKT so Adam Kay awarded the prize to George’s by default. Controversial, exciting stuff!With a high standard of perfor-­

mance from all five medical schools and with such a close result, the spirit of competition in the UH Re-­vue is still going strong. George’s were the victors this year but as to who will claim the Moira Stewart Cup in 2012, it is anyone’s guess .

Over already? Yes London, unfor-­tunately, this is the last issue of the Medicalstudent newspaper for this academic year. If you have like what you have read, please do get involved with this publication – it is an invalu-­able resource for London medics;; run entirely by students it needs people like you to contribute. Get involved.Last month, Medgroup attended the

BMA National Medical Students Con-­ference at Edinburgh University. Issues brought to the table included the NHS reforms, tuition fees and the UKFPO. I urge you all to familiarize yourselves with the proposed NHS shake-­up as this will affect us more than it will af-­fect the current workforce. UKFPO continues to be a topic of much de-­bate and the results of the Situational Judgment Test pilots are currently be-­ing consolidated. Please do consider doing an SJT pilot. I can assure you that not only will it be incredibly use-­

ful to your juniors, but to you too.Reflecting on the past year for the

Medgroup, the main achievement has to be this newspaper itself and the credit for that goes to John and his team. We’ve also managed to create a new social event: “Adrenaline” and we hope this will feature in the medi-­cal school calendar for many years to come. The aim of Medgroup is main-­ly to act as a networking tool for the London medical schools and to keep intra-­London rivalry / banter strong. Congratulations to St George’s for their success at the UH Revue and ICSM for the UH Hockey and Netball.Medgroup will meet for its

AGM on Friday 20th May at 7pm in the ICSM Reynolds Bar .

It has been a quiet few weeks for RUMS. We’ll be keeping up our good work representing RUMS students on important changes happening to the curriculum. The term will kick off with the Sports Ball where we’ll celebrate the achievements of our sports teams over the year. We will also be drink-­ing Huntley Street dry as we move into our brand new union building, com-­plete with cafe and basement venue. Welfare events will continue in

term three, with de-­stress events planned to help you chill out during revision, and welfare seminars to give you advice after the results come in. For those finalists reading, make sure

you also keep a look out for the launch of the RUMS Alumni Association!Finally, as this is the last Medi-­

calstudent of the year, I’d like to say good luck to all RUMS students in their upcoming exams, whether they be first year or final year. I look for-­ward to celebrating with you all at the Summer and Finalists’ Balls .

April edition corrections

The writers for the article “BMA fails to reject reforms” in the April edition of the Medicalstudent were incorrectly printed as Ellis Onwordi and Rashmi D’Souza. The correct writers were Peter Woodward-­Court and Rashmi D’Souza.

The RAG image on the front page of the April edition of the Medicalstudent was found to be taken by James McEntee.The Medicalstudent team apologieses for these errors.

Image by Alex Lai

Here’s looking at you kid. Image by Alex Lai

May 2011 medicalstudent4

News

Imperial tops UKFPO scores

Anand RameshGuest writer

Imperial College London and Barts have come first and second respec-­tively in the rankings for the UK Foundation Programme application scheme. Imperial, who have consist-­ently appeared in the top five, topped the table with an average applicant score of 81.3. However, other London schools did not disclose their results.The UK Foundation Programme is

the bridge between medical school and further training, to reinforce key clinical competencies, including management of acutely ill patients, and generic pro-­fessional skills. In order to be allocated a job within a particular deanery, ap-­plicants go through this scheme which produces an individual score based on three categories: ‘academic’, ‘white-­space’ (testing professional skills) and ‘excellence’ (prizes, publications etc).So why did Imperial and Barts do

so well? The strong academic tradi-­tion of both schools undoubtedly will

have helped. Furthermore, Imperial av-­erage around five or six points in the ‘excellence’ section, whereas a star-­tling 60% of applicants nationwide score zero. The final scores also in-­clude points for intercalated degrees. According to Barts, they only allocate these to a proportion of intercalators (some give points to all who interca-­late) so to have come second overall despite this reflects candidates’ over-­all strength in the application system.No information could be obtained

as to the performance of the other London medical schools. The UKFPO could not provide us with a full league table, and the individual schools have refused to tell us their position. Indeed the Head of the Foundation School at St Georges stated that the informa-­tion was “not in the public domain”, “inappropriate” to publish and need-­ed to be contextualised as all schools are relatively similar. This is strange, given that if it didn’t matter, why have a table like this in the first place? Furthermore, why were Impe-­

rial and Barts open about disclosing

their rankings while there has been silence from the others? Such ques-­tions will no doubt fuel speculation as to the performances of the other medical schools in the application scheme, and reasons why they did not want to provide this information.But does the score really matter?

Certainly, the domains the Foundation Programme aims to develop are the ba-­sis for the three sections of the appli-­cation form and thus it is a reasonable means of assessing candidate suitabil-­ity. However that hasn’t stopped more tinkering with the system. Next year there are purported changes to the “ex-­cellence” section, with some schools advocating it being removed alto-­gether from the application scheme. A more definite alteration is the replace-­ment of the ‘white-­space’ questions amid concerns that because they are based closely on the personal specifi-­cation of the UKFPO, then model an-­swers can be tailor-­made and sold on the internet. The Improving Selection Foundation Programme (ISFP) project plans to introduce Situational Judge-­

ment Tests (SJTs) to test professional and judgement skills in a timed ex-­amination format, as foundation doc-­tors often must make decisions without the luxury of significant rumination. The SJTs have already been piloted

in twelve UK medical schools and two overseas medical schools in March and April of this year. The ISFP project has also piloted an Educational Perfor-­mance Measure (EPM) framework as a means of standardising the way medi-­cal schools determine scores on candi-­dates’ overall performance throughout medical school. If these changes are indeed implemented they would come into effect for those applying in 2013.The UKFPO ranking is clearly

not going to be the only way of judg-­ing quality of candidates from UK medical schools, and what doctors do to extend their CV beyond the foun-­dation years is clearly fundamental. However the very fact that this table is made each year clearly shows the scores have some value to them, and Imperial and Barts can be justifiably proud of their positions this year .

Research in brief

ICSM: Researchers at Imperial College are hopeful that the discovery of a protein secreted by the tuberculosis (TB) bacteria will pave the way for a new vaccine against the disease. The protein, EspC, is not present in the current BCG vaccine. Because it triggers a stronger immune response than any other known molecule it could be used alongside the BCG to provide added immunity, helping relieve the burden of a disease which kills 4700 people a day.

RUMS: Those who regularly work more than 11 hours a day have a 67% increase in their risk of heart disease than those working 7-8 hours, according to a study of over 10,000 civil service employees. The research, published in the Annals of Internal Medicine, also found that adding work hours to patient assessment helped GPs to more accurately predict the risk of heart disease and suggests that this should become standard practice in consultations.

BL: The density of a woman’s breasts may be one of the strongest indicators of her chances of developing breast cancer according to Professor Jack Cuzick at Bart’s. The women with the densest breasts have four times greater chance of developing breast cancer than those with the least dense breasts. Published in Lancet Oncology,

SGUL: Researchers have discovered that using an anti-epileptic drug, retigabine, to activate Kv7 potassium ion channels reduces contractility of the uterus. It is hoped that this discovery could lead to a novel treatment to help prevent premature births. Although survival rates have increased, premature birth remains the biggest killer of babies under one in the UK often causing breathing and feeding difficulties, and can lead to blindness, hearing loss and learning difficulties in those born very early.

GKT: A search for genes relating to alcohol consumption has identified. AUTS2, a gene previously linked to autism and ADHD, is found to have a role in regulating how much people drink. The gene is particularly active in areas of the brain linked with reward mechanisms and tends to be more active in those with lower alcohol consumption. Additional investigation demonstrated differing AUTS2 activity in mice selectively bred according to their voluntary alcohol consumption.

It will all be worth it in the end. Image by Chetan Khatri

medicalstudent May 2011

News5

Diary of an FY1Junaid Fukuta on the infamous on call, weekend-style

Now, I am one of the great-­est fans of the principles of the NHS and am very vo-­cal about keeping its core

values. But having worked in it I see that it is one of the last archaic institu-­tions in our country and let me explain why;; unlike other well known three letter acronyms such as KFC, HMV and even DFS, all hospitals effective-­ly close on weekends. This leads to a mad frenzy on Friday afternoons while every ward hunkers down for the week-­end, in a way similar to towns in the path of a hurricane, and unfortunately that hurricane is the house officer on call, and this weekend was my turn.I turn up on Saturday morning

bright eyed and bushy tailed with a sense of nervousness because I am not sure what to expect. My SHO helpfully points out that 60% of F1s will cry on their first weekend on call, whether to goad me or comfort me, to this day I am still not sure.

“A patient who, if they were not at-tached to a cardiac monitor showing elec-trical activity, would easily be mistaken as dead already”

Nevertheless I pick up the ‘hando-­ver’ folder which contains a list of patients and bloods to review from all the wards. I look at it and my jaw drops as I have 75 bloods to review and it seems every patient on every ward

is deemed high risk. After the initial panic I race off to the wards to start but then get my first bleep. Now nurses, like all professions, will have brilliant ones and not so good ones, and de-­pending which type is working during your shift will have a huge impact on your weekend on call. Good ones will start the phone conversation with: “I know you are busy but I have a patient, named X with X past medical history.” The not so good ones start with: “you know my patient” and with the expec-­tation that you will know all 600 pa-­tients in the hospital, plus have the tel-­epathic ability to know which one they are thinking of at that exact moment.Luckily most of my bleeps are from

the former variety and quickly 15:00 arrives after having seen an unrespon-­sive patient, a perforated bowel, veri-­fied a death, and treated fast AF. I was thinking to myself time for lunch when I am bleeped again to see a patient with a systolic of 45. Bollocks. It was less because I am worried about the patient and more because I was starving and needed a drink of water. I arrive and am dealing with a patient who, if they were not attached to a cardiac monitor showing electrical activity, would eas-­ily be mistaken as dead already. After an hour of stabbing him with needles to get blood and IV access I finally sta-­bilise him and am writing up my notes when the nurse taps me on the shoulder and points out that the patient opposite has dropped their oxygen sats and their respiratory rate is increasing. I give out a deep sigh and go and see them. All

the while I am getting bleeped from all over the hospital to see sick patients. It seems like every patient wants to die on me today. I finally start treatment on the second patient when the nurse sheepishly points out that the patient next to the original one has just start-­ed bleeding massively from their cath-­eter, and then my bleep goes off again.Now I thought I was mentally tough

having survived the ordeal of pass-­ing about a million exams to finally get the title Dr but it all paled into in-­significance at that moment because I was ready to throw in the towel. I just wanted to sink into a little hole and bury myself. This is not the way it should be;; why is only one junior doc-­

tor...screw that, why is it only me hav-­ing to deal with all 600 patients. How can this be possible? I am about to cry, me a fully grown man, am about to break down infront of 16 patients and three nurses and cry like a baby. I stare at the floor and am about to blub-­ber when a senior staff nurse, who has seen this more times than anyone takes me by the shoulder, gives me a mug of steaming hot coffee with 15 teaspoons of sugar in it and says: “Take five min-­utes, you are no use to anyone in your current state. Oh yeah and try some of my Jamaica Ginger cake.” I do as I am told like a ten year old boy and force the cake into my mouth. After five minutes I feel better, refocused and

ready to tackle the haematuria patient.The rest of the evening goes pretty

much as awfully as what had preceded it and at 21:30 I arrive at the handover meeting a shell of my former self. I have had one cup of coffee and a slice of gin-­ger cake all day and have not stopped to drink water or pee. After the meeting my SHO asks whether I cried or not, I proudly say no while thinking how close it got. “Good” he replies “because I made that stastitic up, see you tomor-­row for more of the same big man” as he slaps me on the shoulder and turns to go home. I think to myself I wish I worked at KFC, when he turns around again and says: “Don’t worry, it gets easier” before he disappeared home .

On Wednesday 13th April the Royal College of Nursing took the unprece-­dented step of voting overwhelmingly in favour of a motion of ‘no confidence’ in the Health Secretary Andrew Lans-­ley and his proposed NHS reform. The motion was supported by 96% of the 497 delegates present, with 478 voting in favour, six against, and 13 abstaining.The vote came on the day Mr Lans-­

ley met with nurses at an RCN confer-­ence in Liverpool as part of the gov-­ernment’s ‘listening exercise’, held in light of deeply entrenched opposi-­tion to its proposals from both pro-­fessional healthcare workers and the public. During the 90-­minute meet-­ing, which was held with 65 delegates, Mr Lansley stated that he was “here to listen, not to lecture” and that he

Nurses take a stronger stand than doctors against Health Secretary

is “sorry if what it is I am setting out to do has not communicated itself”.However, even the nature of the

meeting drew sharp criticism, as nurses expressed their anger at Mr Lansley’s decision – viewed by many as a snub – to address a small delegation of nurses rather than the conference as a whole.

“All this comes after the BMA’s decision on the 15th March to adopt a less robust approach against the Health Secretary”

The government announced its plans to conduct a consultation on April 4th in the face of growing, cross-­party criticism against its Health and Social Care Bill. Other healthcare groups widely opposing the bill as it currently stands include the Brit-­ish Medical Association, the Royal

College of GPs and the King’s Fund. There is ever-­growing concern

that the proposals, which include plans to open up the NHS to more pri-­vate healthcare providers and place the bulk of the NHS budget under the control of GP consortia after the scrapping of Primary Care Trusts, will result in the widespread priva-­tisation of the NHS. The RCN’s vote has added to the pressure that is now building on all sides for the govern-­ment to either make profound chang-­es to the Bill or to scrap it entirely. All this comes after the BMA’s

decision on the 15th March to adopt a less robust approach against the Health Secretary, choosing to reject a no confidence motion against the Health Secretary in its special repre-­sentatives’ meeting but also demand-­ing that the bill be withdrawn. There is also mounting opposition to the fact that the government has looked

only to GPs to establish consortia and manage the bulk of the NHS budget.Peter Carter, the general secretary

of the RCN, told the BBC’s World at One that “It’s foolhardy to invest £80bn into GPs – what you should be doing is involving more clinical staff, not just nurses but allied health pro-­fessionals, consultants in hospitals”.The government’s handling of the

NHS has been placed under fierce scrutiny in recent months. Redun-­dancies and ward closures imposed by cuts to hospital budgets and in-­creasing waiting times have been met with demonstrations and rallies. In addition, the Federation of Sur-­

gical Specialty Associations wrote a highly critical open letter to the Guard-­ian on the 18th April indicating that it suspected that treatments were being rationed, and that therapies “to seri-­ously improve the quality of [patients’] lives” were being sidelined in favour

of lists of procedures “of low clini-­cal effectiveness”. The letter asserted that “The only justification for these lists can be that they are a means of reducing expenditure at a time when the NHS faces a financial crisis.”Political pressure is also mount-­

ing, with the coalition government in-­creasingly divided. Liberal Democrat activists passed a motion criticising the proposed reforms and four Tory MPs – Dr Sarah Wollaston, Doug-­las Carswell, Anne Main and Charles Walker – signed a cross-­party motion in March insisting that Mr Lansley lis-­ten to the worries of patient groups and healthcare experts, weeks before the government’s listening exercise began.It seems that Mr Lansley’s gov-­

ernment will have to demonstrate that it is making substantial chang-­es if it is to win back the confi-­dence of nurses and other health-­care workers across the country .

Ellis OnwordiGuest writer

Coffee, glorious coffee. Image by Chetan Khatri

FeaturesFeatures Editor: Neha Pathakfeatures@medical-student.co.uk

May 2011 medicalstudent6

Medicine, drugs and alcohol - the most dangerous of all cocktails

I recall listening to a programme on BBC Radio 5 Live in early Febru-­ary, when I began to hear the sto-­ry of a woman who had become

dependent on alcohol. While drinking cans of Guinness, she explained over the phone that she was a wife and a mother, and was about to enter reha-­bilitation after coming to terms with her drinking problem. While a dis-­heartening and increasingly common case of substance addiction, this story was made more striking by the fact that she was a doctor -­ a GP, no less. From alcohol to ampheta-­

mines, cannabis to cocaine, diazepam to DF118 -­ drugs, both legal and ille-­gal, when abused -­ are major causes of harm to individuals and society. Last year, Professor David J Nutt’s compre-­hensive analysis of the harms posed by each drug made a striking con-­clusion – alcohol is the most danger-­ous drug facing British society today,

more so than heroin or crack cocaine. Medical professionals are as prone

to addiction and drug-­related harm as the general population -­ the GMC’s annual reports show that misuse of drugs is a common cause for referral to the Health Committee. There is even strong evidence that doctors are more prone to abusing certain substances, in particular opiates and tranquilis-­ers, more than the general population. In contrast, there have only

been a few surveys in recent times about the lifestyles of medical students

in the UK. Taken together, they sug-­gest that that medical students are just as likely to drink excessive amounts of alcohol and experiment with illicit drugs as other students, despite their

(supposedly) greater knowledge of the potential hazards of this behaviour. In one of the largest of such surveys by Ghodse et al in 1994, a significant mi-­nority of medical students was found to either persist in or develop poten-­tially harmful substance use behav-­iour. By recognising this minority and the potential risk of substance abuse by these individuals as practising doctors, the authors concluded that “the scope for preventive efforts is considerable”.There are several elements to ad-­

dress with the issue of medical students consuming illegal drugs or abusing legal intoxicants – firstly, individual health, both mental and physical, sec-­ondly, the ethical and moral aspects of future medical professionals engaging in drug use, and finally, the potential hazards students might pose to patients.But why do medical students abuse

substances when they should be best placed to know the harms? What are the potential consequences? And what can be done to prevent medical students from becoming addicted to drugs?

There are several factors that might make medical students more likely than the average student to consume hazardous amounts of alcohol or abuse illegal drugs.Firstly there is the course itself -­

five or six years, each with competi-­tive examinations and a large amount of information to learn. These pres-­sures can contribute to feelings of demoralisation and a tendency to relieve stress through drinking.Additionally, high achievement

and competitiveness are linked to mental health problems such as de-­pression and anxiety, for which the use of alcohol and drugs may serve as maladaptive coping mechanisms.With alcohol, there is a drink-­

ing culture ingrained within the medical profession that is emphati-­cally encouraged by student un-­ions, older students and even doc-­tors all the way up to consultant level.Finally, students may also believe

that they are not at risk of harm because they have been educated to spot all the

signs of dependency. It is this belief that is particularly dangerous, as there is no discrete divide in time between addiction and non-­addiction – the grad-­ual process of dependency can catch people by surprise, most of all doctors.A motion discussed at this year’s

Student BMA Conference was wheth-­er or not medical students should be registered with the GMC and subject to the same Fitness to Practice regula-­tion as doctors. One argument for the motion was that while students are not doctors, their behaviour in the public domain does reflect upon the medical profession, and hence misdemeanours should be treated with the same degree of scrutiny. On the other hand, medical schools already take the issue of fitness to practice seriously, and if a student is found to be behaving inappropriately under the influence of drugs or alco-­hol, they could risk disciplinary ac-­tion and suspension from the course. Some would argue that the conduct

of a first year and a final year student cannot be regarded as the same, where-­

“there is a drink-ing culture ingrained within the medical profession”

Crack, coke, booth, blow, railers, snow, ringer, divits, toot, cola, rocks, blast, white dust, ivory flakes, nose candy, mobbeles. Cocaine. Image by Chetan Khatri

From alcohol to exam-doping, Bibek Das takes us on a “trip” through the darker side of

medical school

medicalstudent May 2011 7

Features

What are “cognitive enhancers”?

Methylphenidate (Ritalin) This drug is better known, due credit to Louis Theroux, for it s use as a

treatment for attention-deficit hyperactivity disorder (ADHD).

It improves concentration, the ability to plan and boosts spatial working

memory which may enable users to remember graphs / diagrams.

However, it has unpleasant side effects including irritiability and insomnia.

In addition, its use is limited by the potential for addiction if abused.

Modafinil This is a central nervous system stimulant usually indicated for sleep

disorders such as narcolepsy or to treat fatigue in multiple sclerosis

(MS).

It can stave off tiredness without the euphoria and cardiovascular effects

brought on by Ritalin. It can improve short-term memory, cognition and

decision-making and, while long-term memory is not improved, the ability

to concentrate for longer periods may allow users to learn more.

The long term safety of both drugs is still lacking and other potential cognitive enhancers are undergoing testing for efficacy and safety.

as others would stipulate that signing up to a medical degree should imme-­diately render students wholly respon-­sible for their actions. It is generally agreed, however, that the key risk is if a student was found to be endanger-­ing patients while on clinical attach-­ments because of alcohol or drug use.A particular problem for medical

students and doctors is the belief that openness about possible addiction might risk moral opprobrium from their peers and harm their career. The fear of castigation by the GMC is a particu-­larly great one, and one that may lead doctors to conceal their addictions. To challenge this belief, there has been a concerted effort to increase openness among doctors and students. For exam-­ple, the confidential counselling service run by the BMA, ‘Doctors for Doctors’, was established to enable all doctors and students to discuss openly sensitive issues, including substance addiction.But are the actions of a young stu-­

dent reflective of future behaviour? We must consider that the path to ad-­diction is not a straightforward one. While many students engage in haz-­ardous alcohol use, only a minority de-­velop serious problems with alcohol at later stages. Instead many factors, such as a family history of alcoholism, are likely to contribute. The personality of the individual is also likely to be im-­portant – alcoholism and cannabis use frequently co-­exist with depression and other mental illnesses, and the sub-­stances may serve as short-­term pallia-­tion of symptoms while aggravating the mental health of the individual in the long-­term. Indeed, while many doc-­tors can claim to have drunk heavily or experimented with drugs as a student, most show no behavioural signs of ad-­diction. As a result, predicting who will or will not develop a substance addiction is a challenge, but there is good evidence to suggest that heavy alcohol or drug use at medical school does increase the likelihood of depend-­

ency at a later stage in life thus high-­lighting the need for early intervention.But what is the best method to iden-­

tify those at greatest risk of those mis-­

using drugs? Some advocate compul-­sory screening programmes, including random urine testing. While this might seem rather heavy-­handed, an alterna-­tive might be a voluntary and anony-­mous referral system. This might be a problem for young students, who have not reached a stage of dependency and do not perceive they have a prob-­lem with drugs. A modified tutorial system, which has been implemented by several UK universities, with im-­proved pastoral support, may be a better method of identifying students who seem to be having difficulties, Alcohol and other illegal drugs are

not the only substances being abused by medical students. Medical students are abusing prescription pharmaceu-­ticals to improve their ability to pre-­pare for and perform in exams. These doping drugs, or ‘cognitive enhancers’ are used by students who believe tak-­ing them will allow them to work for longer hours, maintain their concen-­tration and retain more information. In November 2007, the BMA Eth-­

ics Department published a discussion paper entitled, ‘Boosting your brain-­power: ethical aspects of cognitive enhancements’. It acknowledged the development and use of these drugs and sought to stimulate public debate on the benefits and harms of the use of drugs such as methylphenidate (Rita-­lin) and modafinil -­ ‘there is a grow-­ing expectation that the use of these so-­called “cognitive enhancers” in the

UK is both imminent and inevitable’.The scale of the problem among stu-­

dents, and medical students in particu-­lar, is undefined in this country, but the problem is believed to be rife in the Unit-­ed States, where students have dubbed the pharmaceutical ‘Vitamin R’. But why do they pose an ethical dilemma? If these drugs are proven to be safe

and effective and enter the legal mar-­ket, would rich students have an advan-­tage over poorer students, who would not be able to afford to take the drug? The idea of competing with pharma-­ceutically enhanced students may seem to many as deeply unfair. To level the playing field, should the use of these drugs be regard-­ed in the same manner as dop-­ing in professional sport? Even if testing could be performed be-­fore exams, students might have used modafinil to improve their learning during the course. But then again – many of us take omega-­3 supplements to prevent memory loss so why should these drugs be treated any differently?Furthermore long-­term safe-­

ty data will still be lacking – whether or not short-­term cognitive enhancement leads to middle age pre-­mature memory loss, cognitive decline or oth-­er deficits, is unknown. In the BMA paper, the authors make the point that our brains selec-­tively filter out some in-­formation and memories, particularly those that are trivial or traumatic. It is not yet clear whether drugs taken to enhance memory will impair this vital func-­tion. This may create a situ-­ation in which user’s brains are ‘over-­enhanced’, leading them to be plagued by up-­setting memories that could cause distress or even psy-­chological harm. Also while memory and attention might improve, the ability to inter-­pret data and form opinions may not. This could lead to a situation where we could lose our very sense of identity. De-­spite this, it is easy to under-­stand why some students may feel tempted by a pill to make them smarter and more alert if it is cheap and readily available. In fact, a quick Google search reveals that websites are currently selling modafinil for around £3 a dose. It is important for the medical

profession to recognise that a sig-­nificant minority of medical stu-­dents and doctors abuse drugs and are susceptible to addiction. Early intervention, specialized support services and emphasis on greater openness among students will need to be essential adjuncts to existing health education programmes, to pre-­vent any impact on professional com-­petence and the quality of care deliv-­ To forget or to remember? Illustration by Gemma Goodyear

“should the use of these drugs be re-garded in the same manner as doping in professional sport?”

ered to patients in the future. Stratifying high-­risk individu-­als in medical school would surely befit a profession that values preven-­tion above cure .

Alexander IstedStaff Writer

FeaturesMay 2011 medicalstudent8

Which is the single most irritating bit of med school? a) exams b) exams c) exams

In 1893, the John Hopkins School of Medicine opened and with it came an examination to be sat on gradua-­tion, in order for graduates to be li-­cenced. This paved the way for the multitude of exams that we must sit

(and excel in) not only to graduate but ultimately for the whole duration of working life. Medical school assess-­ments have evolved from long essays and even oral examinations to what we encounter today, multiple choice papers and OSCEs. But do the exams as we know them make good doctors?With thousands of students at each

medical school, the logistics of using an assessment format requiring more than

a computer to mark the papers poses difficulties -­ it is somewhat implausi-­ble to have sufficient examiners grad-­ing written essays or oral presentations. There is still room for essays in the curriculum but they tend to represent far less weight in the overall marks.Thus we very quickly learn to know

and love multiple choice questions, or MCQs. They are the bread and butter of medical school examinations as they

appear to be the best method of testing

the specific medical knowledge of stu-­

dents, often used in conjunction with extended matching questions, or EMQs. MCQs and EMQs are cheap to mark

as they use a computer, can cover a broad range of topics, and are widely considered to be reliable. However they have their downsides -­ they can lead to students learning solely to pass the exams and not to broaden their medi-­cal knowledge. In the final weeks be-­

What’s an Easter holiday again? Image by Giada Azzopardi

“Do we really want junior doctors who have only ever glanced at medical ethics lecture?”

medicalstudent May 2011 9

Features

fore the exams, many students, realis-­ing they may not have afforded enough time for a certain topic will not learn it, either in the knowledge that they can get more marks by prioritising other topics or in the hope it will not feature too heavily on the exam. Ei-­ther way this mentality can result in gaps in students’ medical education.An unnamed student from UCL

looking back on MCQ and EMQ ex-­ams commented “I couldn’t tell which went well and my feelings on the day never reflected how well I ended up doing in the results”. It is a common sight at the end of

an exam;; students reflecting on their performance with comments like “I guessed half of them” and “I could narrow it down to two of the options”. While we are all grateful that exams are generally not negatively marked, a large element of exam success seems to rely on how well you can make educat-­ed guesswork. If someone has to resort to this, it reduces the reliability of the exam system -­ they could sit a similar test the next day and get a markedly dif-­ferent result. Conversely, EMQs give far more options, making guessing less reliable and influences the results less.Another shortfall of MCQ style

questions is that it can be difficult to test subjective, non-­scientific parts of curriculum like ethics which would favour essay based exams. These sub-­jects tend not to require the usual ‘parrot-­fashion’ learning that the ma-­jority of our revision entails and so students often don’t learn them in great depth in the knowledge that they can ‘blag it’ on the day. The MCQ style allows for this to happen and could potentially over represent how well medics understand these issues.Do we really want jun-­

ior doctors who have only ever glanced at medical ethics lecture? Neither MCQs nor EMQs allow

for testing of a student’s extended writing skills, potentially result-­ing in junior doctors having barely written a full sentence since GCSE English and perpetuating doctors’ notoriously poor handwriting. Hav-­ing said this, essay based exams are a notoriously unreliable method to get a fair and standardised mark.In recent years the ‘true/false’

question style has been phased out of the assessments at many uni-­versities in accordance with the GMCs recommendations that state that it is difficult to construct ‘true/false’ questions which are difficult enough without being ambiguous.Most medical schools assess their

students annually with one large set of exams at the end of the year. This has the danger of causing students to sim-­ply cram all of the information for the exam, utilizing their short term memo-­ry, such that by the time they are junior doctors, and even by the time they are in their clinical years, they may have forgotten great chunks of teaching.An unnamed GKT student said

“with the major exams at the end of He looks through hazy eyes at his mountain of books and groans. Not again. Image by Chetan Khatri

the academic year, those who manage to ‘cram’ in their lecture notes tend to do better in exams. Instead of becom-­ing a test of application of knowledge, the exam style favours those who can retain knowledge over the short term”.It seems that all of the examination

styles have their pros and cons, but it doesn’t look like MCQ/EMQ style pa-­pers are leaving any time soon. Does this mean that doctors of the next generation will be ethically unsound, with significant gaps in their educa-­tion, poor long term memory of the theory that got them there and unable to write any prose longer than what you can fit on a prescription pad? Well as the current system of assess-­ment has changed relatively little in the last 30 years, it looks unlikely that the exam format is having a detrimen-­tal effect on the quality of doctors. This may be due to the fact that

much of what makes you a good doctor relies on your clinical practice which is tested in a different way entirely. OSCEs or ‘objective structured clini-­cal examinations’ are a cornerstone of assessment when we reach our clinical

years and have stood the test of time. They pose staged clinical scenarios, in which you take the role as FY1 doc-­tor, testing hands on skills, history

taking, and communication skills, all of which are skills which are perhaps more important in day to day life on the wards than learning Hesselbach’s triangle or the complement cascade.The curriculum will always adapt

to include whatever the GMC feels current doctors lack, for example in recent years a far greater emphasis has been placed on the patient centred approach and communication skills. Ultimately the fear of constant ex-­

amination drives us, keeping us on our toes, and as long as the examination methods remain and broad and com-­prehensive as possible, whilst being lo-­gistically realistic for the universities, they will still churn out good doctors .

“Ultimately the fear of constant examina-tion drives us”

The psychology of the MCQ

Did you know..?

Some studies show that option B or C is more likely to be a correct

answer than A or D. Luckily enough, evidence also suggests that

students are less likely to pick option A or option D.

if you answer every question as option A, you are more likely to get a

higher mark that guessing randomly.

The concept that you should ‘follow your gut instinct’ is a myth. Data

from over 20 studies shows the likelihood of changing from ‘wrong-to-

right’ is almost three times more than the more painful ‘right-to-wrong’.

So check, check and check again to get those extra marks.

If two options are opposite each other, chances are one of them is

correct.

The longer the answer, the more likely it is to be correct (especially in

psychiatry).

The 1980s saw a surge of evidence to show that men outperform

women on MCQs despite similar levels of knowledge resulting in a long

debate over the gender bias of assessment in medicine, dentistry and

economics. Recent evidence argues strongly against this. For now, the

jury is still out.

CommentMay 2011 medicalstudent10

Comment Editor: Sarah Papecomment@medical-student.co.uk

The past 15 years have seen the issue of patient choice being highlighted in the mass media as a positive way for-­ward for the NHS. The Labour Party used it as a key point in their manifes-­to for the election in 1997, when Tony Blair was elected. It is also mentioned as part of the reform of the NHS cur-­rently being reviewed in the House of Commons -­ although many just see it as a cover up for the proposed cuts.Patient autonomy is surely a good

thing for patients it would seem at first glance;; it allows them to make rea-­soned decisions for themselves and ex-­perience complete autonomy. Well, this might be great for medical ethics, not to mention a good way for doctors and politi-­cians to pass the buck, but the major-­ity of patients don’t have an expert knowledge of how their bodies work, where diseases act, or the effects and interactions of treatments and drugs. Would it not instead make sense to have the doctor, who has been put through a great deal of training and has much more experience of these situations make the choice for them?How can our patients be expect-­

ed to read, understand and weigh-­up the pros and cons of the medi-­cal literature regarding their illness in a rational academic way? Thanks to the rise of the internet there is a moun-­tain of information on health acces-­sible to the masses, but often they do not have the skills to critically appraise the data and studies they find. Look at the MMR scare: the data collected was flawed in many obvious ways yet thousands of people risked their child’s health after hearing the information reported in the media. Knowledge without understanding is dangerous, as it can lead us to make poor deci-­sions with unjustifiable confidence.Many patients are unlikely to even

find the information they need to make an informed decision. There is tech-­nically an accessible and easy to use

site called NHS choices available to anyone who wishes to use it. Yet first consider that a large proportion of pa-­tients that require medical care are elderly, and 60% of over-­65’s have never accessed the internet in their lives. This makes their job of assess-­ing how and where they would like to be treated a great deal more difficult.As far as the tax payer is concerned,

it makes no sense to pay a great deal of money to train doctors if they are no longer going to make decisions. Un-­doubtedly it would be much cheaper to have a nurse hand them a leaflet about each treatment. However this isn’t hap-­pening at the moment, and we all know

how keen NHS trusts are to cut costs. Why? Because the lay

person still needs an expert opin-­ion, without which they run the risk of making a potentially fatal mistake.Furthermore, a doctor is able to take

a much more objective view of the situ-­ation, removing as much emotion from the decision as possible. Sometimes the best treatment is not always the most obvious, or one which the patient would ever decide upon. When patients are physically in distress it can be difficult to see the wisdom of seemingly indirect treatments or so called “watchful wait-­ing”, but in retrospect they are often grateful for conservative treatments. Of course, all patients will decide

that they want the gold standard treat-­ment. Looking at the current NHS

budget restrictions, it hardly seems fi-­nancially viable for every patient to re-­ceive the very best -­and usually most expensive-­ care. Rationing of services to those who need it most and will-­derive most benefit is what differen-­tiates the NHS from private health-­care providers, and allows the service to remain free at point of access for everyone -­ one of Bevans underlying principles. There has to be some kind of price to pay for free healthcare. Lack of complete choice is that price.Then we come to choice over pri-­

mary care services. GPs are distributed to make sure that there are enough doc-­tors per area, and to meet the needs of the local population. If patients start to choose exactly which GP they see and where, this will undermine the whole system that was put in place. This would inevitably lead to greater waiting times, which can’t be good for the health of the local population.An increase in waiting times isn’t ex-­

clusive to primary care. As patients get increased choice over where they are treated, the newer, nicer looking hos-­pitals with a good reputation will suf-­fer from exponential growth in lengths of their waiting times. Resources are carefully planned so they will meet the needs of the local population. If people start flocking to certain hospitals from further away, the provision of care will

no longer be evenly spread, leading to a distortion to the care that patients receive.Should everyone be al-­

lowed choice over their own health care? Surely some people will be more com-­

petent than others. Without a way of distinguishing between these levels of competence, we cannot vary the choices we give to patients. It would be very dangerous to start giving every-­one control of their own care, but we can’t deny everyone on the basis that some people aren’t competent either.Having control over our own care

does make the majority of people hap-­py as they have control over that area of their lives. However, I’m not sure this is for the benefit of their health, and is instead a concept used to win over a few extra votes for whichev-­er political party wants to flaunt it .

A long time ago, when life was still lived in black and white, we had films like Doctor in the House and Carry On, Doctor. These movies por-­trayed hospitals as hilarious places, with junior doctors having extra-­mar-­ital MDT meetings in the broom cup-­board with the saucy nurses, all the while dodging the wrath and ire of their consultants and senior admin-­istration in the form of Kenneth Wil-­liams. While these films are funny in their own right, we can also look back on them and laugh at the mediaeval way in which medicine was practised and portrayed only a generation ago.In particular, we like to think that

paternalism in medicine has had its day. The idea that a consultant, a god among men in terms of intellect and charisma, would tell you what you had and would promptly treat it as they saw fit while you, the patient, gushed with praise and admiration for them, all the while trusting them unquestion-­ingly is now unfashionable.. There are many reasons to drop the ethos of “doc-­tor knows best,” least of all being an honest humility within the profession.It may sound surprising but pa-­

tients actually enjoy making deci-­sions about their bodies. In a related field, I am far happier when the bar-­ber asks me how I want my hair cut than when he decides that the “Justin Bieber” is the right look for me. There are very few things in our lives which we can control and we can be thank-­ful that our bodies are one of them. It is therefore jarring to have that con-­trol taken away by a professional who professes to know better than we do.So choice makes patients happi-­

er, you say;; so what? So everything! Studies have shown that patients who are actively involved in their own care compared to those simply fol-­lowing doctors’ orders. It has become apparent that these autonomous pa-­tients are more adherent to their treat-­ment and get better sooner. What’s more, they report fewer side-­effects and a better overall quality of life.There are worries though that in-­

Head to Head

Does patient autonomy threaten patient health?

the majority of patients don’t have an expert knowledge of

how their bodies work and

the effect of treatments upon

it

YES

Well, if truth be known, it was more a case of why not than anything else. I sup-­pose you could stereotype me, as many before you have done, as that ‘white, well educated head girl, who was some-­what of an all rounder at School’. You know, the girl exhibiting an annoying type of well achieving;; a well achiev-­ing which somewhat borders the line of being standardly, predictably, boring.Medical School was to me, as some

have audaciously phrased it ‘simply the next logical step’ though there was a struggle to choose between the allure of free time -­ a pre-­requisite to a humani-­ties degree-­ versus the reality of a REAL job prospect and financial security.So what of the negatives? Why not

consider Medicine? There are Job pros-­pects, career Progression, and Medical Students? Gosh! Have you heard the stories and the philosophy underly-­ing them? Philosophies which scream tantalisingly ‘work hard, play harder’. Who doesn’t want to invest at least five years in to such a heroic combination of academic prestige and drunken antics?Although in saying this, I am now

of the persuasion that Dentistry of-­fers better prospects. Though a de-­batably harder course, with less acco-­lade, it most certainly houses a much easier lifestyle...if you get my drift.Unlike many others in my posi-­

tion, you may be surprised to hear that I actually have no parents, nor in fact any family who have entered higher education. Which makes me the black sheep of the family perhaps? Can I honestly see myself as a

Doctor you may ask? In fact, can oth-­ers honestly see me as a Doctor? But then what actually constitutes a Doc-­tor? What qualities? What passions? I ask you to ponder these questions.I, contrary to what you may believe

by the horrifically obnoxious open-­ing to the article am not in reality ar-­rogant, obnoxious or even cold. In fact I would perhaps pride myself on per-­sonifying the opposite. Originally it was somewhat of a challenge to believe I could make a decent Doctor, or even take myself seriously. Yet, with every day that I dip and delve into the medi-­cal world, I increasingly believe that I can fulfill this role with the respect and passion it deserves. My compas-­sion and care for those around as well as the excitement that comes with a field as diverse, challenging and inspir-­ing keeps me going even when I reach the depths of the deepest dark lulls of cell biology and biochemical pathways!I am thankful everyday that I ful-­

filled a stereotype which helped me get into medicine, so as I sit here in my Laura Ashley room typing on my mac (being a d**khead is cool), I am thank-­ful that my boring all roundedness and conforming led me to a path such as this. Anarchy is for the insecure anyway! .

Why medicine?

Catherine Longthorpe explains

Toby FlackGuest Writer

Rhys DaviesGuest Writer

Patients who are actively involved in their own care

compared to those simply fol-lowing doctors’ orders are more adherent to their treatment and

get better sooner

Commentmedicalstudent May 2011 11

creased patient choice will reduce doc-­tors to simpering sycophants, pandering to their patients’ every whim, handing out leaflets and reduced to mere infor-­mation points. While this fear is under-­standable, it is also unfounded. If we let the spoilt brat in the sweet shop have

more choice, he’d

pout and shout -­and probably swear these days-­ and ask for the whole store, but our patients don’t want all the medicine, they just want what is best for them for treating their symptoms. Admittedly,

they might ask for the latest wonder-­drug, Herceptin et al, even if it is inappropri-­ate for them but patient choice should replace paternalism, not a doctor’s integrity. Ethically we are not com-­pelled to provide treatment that we do not think will provide a benefit. If a patient demands an inappropriate drug, because of what their friends are taking/what the Daily Mail says/the pretty colours, it is our place as doctors to inform and educate them, not to kow-­tow to their wishes. Pa-­tient choice sounds dangerous;; in-­formed patient choice sounds sensible.Though a doctor will hopefully

know more about their disease, and the treatment thereof, only the patient can fully know themselves. While a doctor might prescribe the most efficacious drug, the patient may prefer a drug that is easier to work into their life. Case in point, Lance Armstrong, the world champion cyclist. When he was first di-­agnosed with metastatic testicular can-­cer in 1996, it was decided that, as well as surgery, he would require adjuvant chemotherapy. The cocktail of choice for this particular malignancy was Ble-­

omycin, Etoposide and Cisplatin. How-­ever, Bleomycin has a nasty side-­effect of pulmonary fibrosis. Unfortunate for you or me, but cycling competitively with lungs made out of rock would be impossible for Lance. It was an unac-­ceptable side effect that would poten-­tially ruin his career and his livelihood. That was why he instead took Ifosfa-­mide – not quite as effective as Bleo-­

mycin but it avoids the side-­effect of breath-­ing through granite. Thankfully, he went into full remission and hurtled on to win the Tour de France in 1999. And carried on winning it for seven years! Would he have been able to accom-­plish this amazing feat if he had submitted to his doctor and taken Bleomycin instead? Who can say – the point is, what might

be best for a person medi-­cally may not al-­

ways be best overall. While the doctor can easily assess the former, only an informed patient can assess the latter.In conclusion, every step closer

towards more patient choice is one more step further away from the anti-­quated spectre of paternalism. It leads to greater adherence to treatment, faster improvement and fewer side-­ef-­fects, which is good news for all con-­cerned. Importantly, it doesn’t mean doctors must hand in their backbones along with their white coats. Instead they have to learn to work with pa-­tients rather than battle against them.With the NHS reforms looming,

and the coilition at war over AV, there many things to be worried about in the governments proposals and promises regarding the future of healthcare. In-­creased patient choice need not be one of them. Instead it should be one as-­pect of the reforms that should be cel-­ebrated and welcomed with open arms by patients and professionals alike .

Head to Head

Does patient autonomy threaten patient health?

NO

This idea of a doctor leading by example in the promotion of health has always been a topic for debate, and is one that medical students take sides according things usually as a result of their own personal lifestyle choices. The role of a doc-­tor includes health advice and health promo-­tion;; doctors are effectively the spokespeople and should therefore model the ideal health status. It is a common expectation within society to

expect members within their reflection to be role models of the brand or product they promote. Af-­ter all, we would expect a gym instructor to have the amazing fitness we are aiming to achieve and a dentist to have perfect teeth that they so readily give advice on ascertaining;; without these perfect imag-­es we easily lose faith in the “brand” so to speak. Therefore, within the medical profession, we as doctors should reflect the image of the good health status that we ask our patients to work towards. Currently health promotion within the NHS

is being tailored towards the reductions in pre-­ventable diseases, specifically those that are cer-­ebrovascular and cardiovascular-­related. Many of these diseases are caused by poor lifestyle choic-­es such as smoking, excess eating, lack of physi-­cal exercise and binge drinking. It is then with-­in the doctors role to avoid such poor choices and reduce the growing burden upon the NHS. This idea of health promotion would involve just

seeming to take your own advice as it were. By this

I mean that they should give the impression of being in good health, regardless of their true health hab-­its. This would mainly involve looking physically fit with BMI within the normal range, after all how can a doctor claim to be assisting the reduction in the ever-­increasing “obesity epidemic” if they can be categorised within group causing it. Furthermore, if the information provider is clearly not taking their own advice, it is likely anything preached about disease prevention would simply fall on deaf ears.Habits such as smoking and heavy drink-­

ing should be conducted behind closed doors, leaving the patient none-­the-­wiser about their doctors’ true lifestyle choices. (This is not to say that I condone this behaviour!)The sheer cost to the NHS, due to the burden

of treating these growing cases of preventable diseases is something that is clearly emphasised throughout our medical degree program and some-­thing that we should all be very aware very early on in our medical career. To go against advice, and to know you are one of those causing mount-­ing debts to our health service, should be enough to cause enough guilt to avoid such behaviours.Moreover, who would want to partake in these

bad lifestyle habits both knowing the future risks to their health risks as well as having seen countless patients suffering as a result of all of these things? Not me, that’s for sure! Off to the gym I go! .

Leading by exampleZainab Sanusi discusses the pros of doctors keeping healthy

“we would expect a gym instruc-tor to have the amazing fitness we are aiming to achieve

Illustrations by Giada Azzopardi

CommentMay 2011 medicalstudent12

A childhood epidemic of gigantic proportions

Children are the future! Well, an expensive future anyway, filled with diabetes medica-­tions, blood pressure tablets and walking sticks before the age of forty. Why should the young be exposed to this predicament? Sheer neglect. The current population of toddlers is being burdened, albeit unwittingly, by their parents. The number of children classified as obese

has reached a shocking level in the United Kingdom. A startling one in five children in London is obese, the highest prevalence throughout the United Kingdom. Terrifyingly, a leading paediatrician who specialises in epi-­demiology was quoted in a Government report in 2004 as saying, “this will be the first gen-­eration where children die before their par-­ents as a consequence of childhood obesity”.

“A startling one in five children in London are obese”

The consequence of childhood obesity is that children are being prematurely afflicted with conditions of adulthood. Last month, a doctor working at Great Ormond Street revealed, stag-­geringly, that teenage patients are being diag-­nosed with Metabolic Syndrome. The associated hypertension, hyperlipidaemia and hyperglycae-­mia significantly increase the risk of developing cardiovascular disease and diabetes at a young age. Compounding the issue is that children are less responsive to remedial drugs such as statins.

Another corollary of childhood obesity has also recently surfaced. Research made public has disclosed that obese children develop big-­ger skeletons to accommodate their increased weight. As a result, their bones exhibit low-­er bone density than lighter people. They are therefore more likely to develop osteoporosis and at a younger age than is currently expected.The shambolic failure over the last twenty years

to stem the flood of obesity has afflicted teenag-­ers, leaving them with health concerns typical of the more aged population. Such an unnatural phenomenon must surely provoke us into action.A causal relationship is often suggested be-­

tween obesity and deprivation. A recent report by the London Assembly asserted that a greater number of deprived neighbourhoods are situ-­ated in London than any other city in England. The report, examining the exponential growth of childhood obesity in London, suggested a causal link between the high rate of depriva-­tion and the high prevalence of obesity. London-­ers are reportedly more likely to buy unhealthy foods for their children, despite food labelling, whilst not encouraging enough physical exercise. However, notwithstanding the association be-­

tween deprivation and obesity, it is clear that not only poor children are affected. It is not uncom-­mon for working parents to buy more conveni-­ent food that does not require preparation time, such as fast-­food takeaway. These foods of-­ten have far less nutritional value than properly cooked meals, and dependence can lead to obesity.In 2007, the Government responded to the wor-­

rying growth in obesity. An unrealistic target was ambitiously set, requiring that England be the first major country to reverse the trend in obesity with-­in the population by the year 2020. It was highly ambitious to think a new campaign would not only

slow down the rise of obesity figures, but actu-­ally reverse them. Frankly, this was pie in the sky. Needless to say, so far, they have failed to

abate the surging obesity statistics. In the pro-­cess, £372 million has been spent on initiatives that included a marketing campaign to promote healthy diets and increased physical activity. Childhood obesity was targeted by declaring war on unhealthy school dinners and increasing the number of hours devoted to physical education.

“Children below the age of five who become obese are innocent victims of pa-rental over-nutrition. Negli-gent parents are undoubt-edly to blame”

The philosophy underlying these tactics pre-­supposed that unhealthy eating in school age children and inadequate physical activity were causes of obesity. This thinking was unproven and the corrective strategy was nothing more than a stab in the dark. It has since been discov-­ered that the majority of excess weight gained by children, is amassed before the age of five. Attempts to prevent obesity by focussing on school age children are therefore futile, particu-­larly if children live an unhealthy lifestyle at home. To be successful, all attempts to lessen obesity must concentrate on targeting the nutri-­tional health of children under the age of five. Children below the age of five who become

obese are innocent victims of parental over-­nutri-­tion. Negligent parents are undoubtedly to blame, although the damage is completely unintentional. Many parents are blissfully unaware their child

has deviated from a normal growth pattern. A Na-­tional Opinion Poll found that only 14% of parents who had an obese child considered their child to be overweight. In 2005, the National Child Meas-­urement Programme was introduced into primary schools. Children are weighed as they commence primary school and weighed once again upon leaving. The programme was intended to moni-­tor childhood obesity levels and many areas dis-­patched letters informing parents if their child was obese. This procedure should be continued so that parents might learn of their child’s condition. The Government has been barking up the

wrong tree by directing its attention at schools. It is imperative that instead it steers its attention to parents of young children. Simple changes should be made to encourage positive parental behaviour. The importance of a healthy diet for toddlers must be reinforced in National Child-­birth Trust classes and the risk of obesity should be warned against. This message should be re-­peated during baby checkups at surgeries and supportive literature provided. Scientists have determined that behavioural therapy to engage childhood obesity is effective when the reins of responsibility are retained by the parents. In con-­trast to efforts made when children are at school, interventions that aim to increase physical ac-­tivity are effective at achieving and maintain-­ing weight loss when confined within the home. Parents must be made aware that between

the ages zero to five, is a crucial period that can largely determine if their child is to become obese. Tackling the issue at this young age will lower the prevalence of childhood obesity. By reducing the number of toddlers who are obese, the Government will finally be able to have a realistic stab at pop-­ping the ballooning epidemic of obesity .

Hospital mobile phone bans long forgotten, it has become the norm for the modern medic to tote a pocket-­ful of shiny smartphone. But what’s so great about these snazzy gadg-­ets, and what are the consequences of mixing mobiles and Medicine? The obvious benefit of smartphones

is that they allow easy access to re-­sources whenever, wherever. Profes-­sor David Cottrell, Dean of Leeds University Medical School, clocked this at the start of the academic year and declared that all fourth and fifth year medical students at the univer-­sity would be eligible to receive a free iPhone ready-­loaded with text-­books, note-­taking apps and prescrib-­ing guides. He said: ‘By equipping our students with smartphones, we are putting a whole suite of training tools and educational resources in the palm of their hand’. Worth £380, the phones provide unlimited email access so that students can communicate easily with their tutors while away on place-­

ments. Calls and texts, however, must be paid for via a Pay-­As-­You-­Go tariff, and those taking up the offer must re-­turn the phones before they graduate. A compact font of medical knowl-­

edge at one’s fingertips may seem fantastic, but is anytime access to an-­swers a double-­edged sword? Face-­book distractions aside, a potential threat of the iPhone as a study aid is the risk of compromising the invalu-­able skill of being able to independent-­ly think up a logical answer without tap-­tapping on the touchscreen. KCL medic Laura Gush says: ‘Nobody can memorise everything, and being able to check facts quickly is great, but you can’t get too used to it as you won’t have your iPhone in the exam room.’From a professional perspective, the

pros and cons of smartphones similarly revolve around access. Thanks to on-­line search tools and reference apps, doctors can rapidly acquire informa-­tion while practising in remote areas or when flummoxed by an unusual case.

Advancing technology could be par-­ticularly useful for GPs carrying out home visits, and iStethoscope’s design-­er Peter Bentley (UCL) promises he has more to offer. ‘I could create a mobile ultrasound scanner and an applica-­tion to measure the oxygen content in blood’, he claimed. Such devices could be invaluable when sophisticated hospi-­tal monitoring is not an option, but only if they work. Like students, doctors must be wary of becoming over-­reliant on mobile technology rather than the clinical skills they have honed through years of training. KCL student Shaun Li pointed out: ‘one of the first things you learn in Cardiology is not to trust the automated ECG report and to inter-­pret the trace yourself-­ even really good diagnostic apps could be inaccurate.’Medical professionals are by no

means the only users of medical apps. In fact, of the thousands of health-­relat-­ed apps available to the UK’s estimated 11 million smartphone users, the ma-­jority are pitched as “patient-­centred”

apps offer help from simple diet and fit-­ness advice to more specific functions. Fertilityfriend, for example, calculates when a woman is most fertile and sug-­gests optimal sex positions to conceive. Step-­by-­step emergency apps have

even helped ordinary people save lives. During the 2010 Haiti earth-­quake, American film-­maker and humanitarian worker Dan Woolley survived 64 hours trapped beneath a pile of rubble with the help of Pocket CPR, which instructed him how to make a tourniquet for his injured leg.Smartphones may also pose disad-­

vantages to patients, however. Unre-­stricted availability of diagnositc apps may carry significant risks for those without a medical background. Con-­sider ‘iCough’, an application currently under development, which formulates a diagnosis by analysing a splutter into the mouthpiece. If the app were to mistake say, pneumonia, for a sim-­ple cold and speedy medical help was not advised, the individual could be-­

come seriously unwell. On the flip-­side, misdiagnosis of a cold as some-­thing more sinister could cause the stressed sniffler unnecessary panic. As apps become increasingly popu-­

lar and sophisticated, doctors and app designers should educate patients about how they can use these tools to their ad-­vantage. Novel technologies need reg-­ulation and rigorous testing, and any emerging apps designed specifically for doctors,should be withheld from the public marketplace. Establishing a diagnosis involves an understanding of the full clinical picture: signs and symp-­toms, and the general impression of the patient.This is too complex a process to be achieved using a smartphone alone. Providing patients and healthcare pro-­fessionals are aware of this and other limitations of smartphones, it should be possible to reap the numerous benefits of mobile health technology, leaving doctors across the UK free to continue playing Angry Birds when at work .

Josie Bretherton discovers the joys and pitfalls of being phone smart

David FisherStaff Writer

Commentmedicalstudent May 2011 13

As I rush about the wards, worrying about hospital-­acquired infections and ev-­idence-­based-­practice and

other gremlins of modern medicine, I can’t help but wonder what things might have been like in times gone by. This is increasignly relevant as we all cower from the threat of an end to effective antibiotics and hurtle back into an era where whiskey and brutal procedures involvinfg hacksaws were regard-­ed as the height of surgical prowess.Yet what if it wasn’t only antibiot-­

ics that we lost, but all technological advances as well? Take Radiology for example. Where would we be if Roent-­gen hadn’t got bored one day and point-­ed his X-­rays the wrong way? Well, it wouldn’t be called Radiology for a start. Imaging would still be a fitting title, except instead of CTs and MRIs, technicians would slaughter goats and read the entrails to obtain such images. The resolution may not be as good but we’d have an outside chance of getting the lottery numbers while we were at it.Haematology would be much sim-­

plified. Instead of cell counts and ab-­normal lineages, all pathology would boil down to a simply decision: does the patient have too much or too little blood. Having too much blood has per-­haps been an over-­diagnosed condition throughout history, but at least physi-­cians knew how to treat it. Not that it was hard – even the ale louts in the local tav-­ern knew how to treat it. Treatment by scalpel or broken glass, it’s all the same. Having too little blood would be

a little trickier to treat but giving blood wouldn’t be too hard. Okay, it might require a little experimen-­tation to get the blood groups right – and you’d have to hope you got it right before the patient, y’know, died – but it wouldn’t be impossible.Cardiologists would still have to

have an impeccable sense of rhythm, but without their fancy telemetry and the machines that go Ping!, their sense of hearing would have to be elevated to preternatural levels. It might even be worth blinding prospective cardiol-­ogy SHOs in order to raise their aural abilities to the level of bats. Or maybe put their doctors’ mess in a local bel-­fry – the point is, there would be op-­tions to perservere with the speciality.Neurologists would still be the same.

No matter what advances in medicine are or are not made, they would still be sipping the finest Cabernet in the hos-­pital canteen and playing Vivaldi in their string quartets during clinics. It is essential in any age to have at least

one such neurologist in the hospital. They add a touch of class to things, like an overly-­expensive painting hung in the entrance foyer. Goodness knows how they’d treat neurological prob-­lems but I don’t even know how they do that now. Hitting people with tendon hammers seems to cure most things.

“this would be a hospital where we routinely sacrifice animals, blind junior doctors and blend up medical students”

Without antibiotics, the depart-­ments of infectious disease and sexu-­al health would face serious setbacks. Even if they could diagnose the par-­ticular nasty – I hear Pseudomonas smells like Pimms – there would be no way to go about treating said bug. The drug cabinets in their clin-­ics would be piled high with cans of chicken soup – well, it couldn’t hurt!On a related note, reproductive

health might not do so badly. They may be without things like clomiphene and IVF but they would still have...ther-­mometers. And nothing raises a flag-­ging libido like a friendly, local neigh-­bourhood speculum. Mm, sexy. They

might also consider commissioning an audit of lunar patterns and local fertili-­ty sites. Although, I fear this might boil down to just gossip and bragging about who’s done it on Hampstead Heath.Endocrinology would still exist,

although with some major complaints from the animal rights groups. Diagno-­sis would fall back to the amusing signs found in clinical examination. Lemon-­on-­sticks, moon face, exopthalmos, hands like shovels, micropenis, gy-­naecomastia – need I go on? Treatment would be less precise;; it would involve injecting extracts of functional endo-­crine organs into patients...after blend-­ing up their original owners, that is. Dogs, pigs, medical students that miss Grand Rounds – none of these lower creatures would be safe from the in-­dustrial strength blender necessary for most Endocrinology departments.This all may sound bizarre but it

does make you appreciate how far we’ve come in just a few hundreds of years of trial and error...mostly error. Admit-­tedly, I like the sound of the chicken soup and the Neurology department. But this would be a hospital where we routinely sacrifice animals, blind junior doctors and blend up medical students. On reflection, probably not.And orthopaedic surgeons...

well, they probably haven’t changed that much, really .

What if...hospitals had no technology?

Rhys Davies ponders an alternate future

Too old too young

I was on the train the other day -­ be-­ing at GKT I spend most of my time on public transport in south London -­ and overheard some children play-­ing I-­spy. As I eavesdropped on their game I couldn’t help but be impressed by the sheer ballsy confidence of one of the boys. Each time the object he had chosen was correctly identified he, instead of admitting defeat, would shamelessly claim that it was in fact a different letter he had told them to use to guess. His control and conviction were impressive, and ultimately won him the game: “something beginning with “d”, “door?”, “no, I said something beginning with “s””, “seat?”, “no it’s all around and begins with “f””, “floor!?”, “No, I said it’s on the ground…”.You get the picture. I had to hand it

to him. This kid had already worked out the vital ingredient in success: absolute conviction in your actions. With my OSCE’s looming this made me feel strangely inadequate. At the age of 23 I still get reduced to a quiv-­ering wreck during the practical ex-­ams, while children not even half my age have already found the key to maintaining strong outward personas. We all know deep down that, no mat-­

ter how much or how little you know, confidence can make or break a situa-­tion. Having spilt a vial of urine, and called a man emancipated instead of emaciated within the initial two stations

of my first OSCE exam, I can definitely vouch for this theory. I was so nervous I’m quite proud that I didn’t throw up to be honest. At least I long grew out wet-­ting myself. I hope. I suppose you lose marks for dipsticking your own urine. When I compare my anxieties to

the cool confidence of the children I see around town, I realised that maybe there is something to the tabloid scare mongering about children growing up too quickly -­ though probably not in such a way to bring modern society to its knees as some articles would lead you to believe. Not only do they have the confidence and sureness of heart, they also have the swagger, the skimpy clothes that I can’t wear, and the con-­stant debt worries of a middle-­aged man.More upsettingly I seem to be get-­

ting younger in my behaviours. As a child we are taught not to stare, a rule I duly tried to follow in my formative years. Yet in the last couple of years I have become aware of a strange devel-­opment, one I can only blame on my medical education. It turns out that I have again started staring at people on the street. Now before I get myself into trouble, you must understand. I don’t stare in a nasty pointed sort of way, or gape out of ignorance like a Victorian at a freak show. No. Now I look out of some unconscious intellectual interest, piecing together signs and symptoms, trying to come to a diagnosis and make myself feel like I’ve actually learnt something in five years. Not that this makes it any more socially acceptable. So, while everyone younger than

myself is apparently ageing too quick-­ly, having sex too early, and dying too young, I am embroiled in a depressing Benjamin Button scenario and regress-­ing back to the time when grazed knees were an acceptable look. This can only mean one thing: that I’m in danger of being overtaken by some young whip-­persnapper. I think I may just give up now and swap places with them. Just think of the perks. I’ll get to nap dur-­ing the day, legitimately take Cal-­pol again, and play with Lego. And apparently I don’t look much older than 15, at least according to eve-­ry bar tender I’ve ever approached.On the other hand I won’t be

able to drink alcohol. More impor-­tantly I’ll have to learn to walk/ride in wheelie trainers, get into Ben 10 (yeah look at my pop cul-­ture references), and be constantly overshadowed by creepily accom-­plished teenagers like Willow Smith.What a dilemma. I seem to be

failing at maturing, yet unable to take more than vague baby steps back into childhood. I guess I’ll just have to skip the whole thing and be-­come an old lady prematurely. Now where did I leave my knitting dear? .

Sarah PapeComment Editor

Kiranjeet GillSub-Editor

CultureCulture Editor: Robyn Jacobsculture@medical-student.co.uk

May 2011 medicalstudent14

Held deep in Imperial territory and with

Adam Kay, an ex-­Imperial student as host,

UH Revue 2011 looked as though it could

have been an ICSM dominated affair.

Up first and making the most of the rela-­

tively sober audience, George’s grabbed at-­

tention with an opening song that started

and ended with a crowd-­pleasing kiss. They

just about managed to keep their heads

above the water with short sketches and

quick scene changes, though their gay bingo

sketch definitely flopped and the final song

failed to make a dent in the wall of noise

from the Imperial crowd they’d not-­so-­clev-­

erly alienated with jokes at their expense.

Up next, the Tourettes-­inducing “BAR-­

TS!” troupe stepped on stage and flew into

a snappy Bollywood inspired dance in some

fetching bottomless burkas which got them

off to a good start with the crowd. Inevita-­

bly, however, the sketches soon descended

into traditional Barts format;; ‘nuff said!’

Imperial had a big task ahead of them as

they were treading their own boards in front

of a crowd of mostly their own supporters.

Those that didn’t use this opportunity to get

to the bar or toilets before the approaching

interval were treated to a ‘topical’ Ship-­

man sketch and left perplexed by sketches

that avoided the usual visual gags in fa-­

vour of words, put simply, nothing could be

heard over the roars of the heckling crowd.

After the interval, RUMS entered the

stage to arbitrary booing which set the tone

for much of the rest of their set and, in-­

deed, the night. They had small moments

of reprieve for their Paediatric-­doctor-­at-­

tempts-­trauma skit and credit must be given

to the cast for soldiering through, but ul-­

timately their sketches fell at every hurdle;;

too long, too wordy and not enough nudity!

Finally GKT, and unsurprisingly, a lot

of AV action here. Videos saw members of

the public attempt rapping (failsafe) and

a girl commit suicide (this, ironically, got

cheers). Credit to them though, when they

deigned to come on stage they impressively

silenced the now habitual booing with a bril-­

liant ‘We buy any car.com’ parody that left

Barts red faced and George’s relieved they

had too many syllables to fit into the song.

The cheeromiter swiftly knocked RUMS

and Barts from the running and Adam Kay let

them decide the fate of the final three. With

Imperial losing this second vote, GKT and

George’s stepped up to the stage for a decid-­

ing arm-­wrestle. However, after attempting

to fill both spots with their own competitors,

GKT were forced to forfeit and the Moira Stu-­

art Cup was thrust into the waiting arms of the

George’s crowd for the first time in 6 years .

The UH RevueREVIEW

FASHION & BEAUTY

Foundations for Summer

EXHIBITION REVIEW

Dirt: The Filthy Reality of Everyday Life

If cleanliness is next to godliness, then the

Dirt exhibition at the Wellcome Collection

might make you feel very sinful indeed.

Upon entering the museum,

you are immediately

faced with probably the

filthiest window you’ve

ever seen: coated with

years of dust and grime,

it represents our most com-­

mon conception of what dirt

is. The way viewers recoil and

look away accurately reflects

our general attitude towards the unclean.

It disgusts us and so we are obsessive

in our quest to get rid of it – out of

sight is, after all, out of mind.

The Dirt exhibition, how-­

ever, makes us confront our fear

of dirt head-­on. It contains six ar-­

eas each dedicated to a different

city and time period. From 17th century

Delft, where the residents scrubbed their

doorsteps each day to defend the moral

virtue of their homes, to the 1854 Broad

Street cholera outbreak in London that

killed over 500 people in ten days. The ex-­

hibition is full of interesting pictures, vid-­

eos and artefacts that demonstrate both our

increased understanding of dirt through

time, and our eternal battle to control it.

Pictures of Fresh Kills, the world’s larg-­

est municipal landfill, just outside of New

York, serve as a stark reminder of the co-­

lossal amount of rubbish we produce, and

our ongoing struggle to deal with it. Three

times the area of Central Park and taller than

the Statue of Liberty, an entire city’s rubbish

was shipped here for over fifty years, de-­

spite most New Yorkers be-­

ing ignorant of its existence.

This attitude is also apparent

in the section of the exhibition dedicated to

the Dalit community in New Delhi and Kol-­

kata. A photo of a semi-­naked man clamber-­

ing into a city sewer, its walls thick with ex-­

crement, both repulses and fascinates. My

horror at discovering that even today, over a

million people work as ‘manual scavengers’

to clear human waste from India’s woefully

inadequate sewage systems was met with

disbelief that the Dalits, who slave so hard to

keep the city clean, are ostracised by a socie-­

ty obsessed with the idea of purity. By ignor-­

ing the waste we inevitably produce, we can

defer responsibility for it to someone else,

then consider them the unclean ones instead.

What is great about the exhibition is its

creative interpretation of the concept of dirt,

which ventures into the metaphorical with

its display of articles from the Deutsches

Jennifer Hung discusses the best

foundation to use this summer

My recent obsession and beauty secret, which has replaced my whole lifetime’s collection of foundation, is BB creams. This stands for blemish balm.

It was originally formulated in Germany by dermatologists for patients who had undergone any cosmetic or interventional surgery on their face. It was designed to help heal the post-op skin faster, by protecting it and soothing the surface, whilst also offering a light cover-up for post-op scars and other acne and blemishes.

In the last couple of years, BB creams have become a phenomenon in South-East Asia and is a swear by amongst all South-East Asian celebrities, most of whom are known for their natural, flawless skin. More recently, it has been making its way to Hollywood.

What makes BB cream stand out amongst countless designer foundations? It’s the regenerating benefits it provides whilst also acting as a long-lasting make-up base throughout the day for all skin types; a true multitasker.

The thing with foundation is that yes, it makes us look great during the day, but at the expense of a heavyweight unnatural feeling on your face all day, not to mention the discoloration of your natural skin if you wear it regularly.

BB cream feels lighter than a moisturiser, yet acts as a skin primer, foundation and moisturiser, whilst also providing properties you could only dream of: skin-brightening, anti-wrinkle, anti-blemish, combating hyperpigmentation (such as dark circles) and healing acne scars. The finish is dewy and luminous, giving you a glow that makeup artists require tons of products to help achieve. Continued use also improves your skin!

Apart from the limited range of tones this product is currently available in, It is definitely worth chec king this product out, and is a great lightweight foundation alternative for the summer!

Products range from £16-£30.Available from a range of websites.

Image featured is skin79 diamond cream

Lauren WellburnGuest Writer

Hygiene-­

Museum in Dres-­

den. What began simply as

an exhibition to educate the public

about anatomy and healthcare soon became

a tool of Nazi propaganda, used to push its

racist ideology and disseminate the idea of

‘racial hygiene’. We see examples of some

of the 10 million registry cards that record-­

ed the hereditary and racial history of the

German population that were used to pro-­

vide evidence for court sterilisation orders

to cleanse the country of ‘undesirables’.

There is definitely something in the ex-­

hibition to interest everybody. Rubbish,

disease and ethnic cleansing: the exhibi-­

tion has taken the idea of dirt and turned

it into something imaginative, unexpected

and informative, and it really works in the

context of the other collections in the mu-­

seum, which are also well worth a visit.

Dirt is on at the Wellcome Trust until 31st August. For more info visit www.wellcomecollection.org

Culturemedicalstudent May 2011 15

AN INTERVIEW WITH...

Rob Laycock of the New Actors Company

It’s the sunniest day in April so far, and I have braved the tube to land myself in Hackney to speak to Rob Laycock, founding member of ‘The New Actors Company’ and director of their latest show, JB Priestly’s ‘They came to a city’. The show itself is based in a post-­

World War II world, where nine indi-­viduals are removed from their every-­day lives and thrown together outside the walls of a strange city. The play examines the concepts of utopian equality and questions the concept of a perfect world;; a concept that would have been of great importance to an audience of world war II survivors. But is this relevant for today’s audi-­

ences? Laycock is convinced that it is: “It’s very relevant [to today’s society]. JB priestly wrote it because he was an-­ticipating what post-­World War II soci-­ety was going to be like. He was very much concerned about the effect World War I had on society, so he felt that if the social role was there, some posi-­

tive good could come out of this sec-­ond huge bloody war. So that’s why he wrote it. The reason why it is relevant

MONIQUE and THE MANGO RAINS Kris Holloway

THE HEART SPECIALIST Claire Holden Rothman

www.oneworld-publications.com

Monique Dembele worked as a midwife in the village of Nampossela, Mali, one of the poorest countries in Africa. Kris Holloway was a Peace Corps volunteer, assigned to help her. ! is book highlights in shocking detail the unbelievable conditions faced by women every day. Proceeds from the book will go to Clinique Monique in Nampossela, set up in Monique’s memory.

Oneworld Publications5th MayISBN 978-1-85168-837-1 £9.99 paperback

A graceful debut, based on a true story. It’s the turn of the century and the world is hurtling towards war. Sharing her father’s passion for medicine and determined to continue his life’s work on heart research, young Agnes White faces society and its prejudices head-on as she strives to become the " rst female medical student. ! is is an upli# ing story of strength, self-belief and following your heart no matter what.

Oneworld PublicationsOut NowISBN 978-1-85168-794-7£8.99 paperback

Claire Holden Rothman

www.oneworld-publications.com

help her. ! is book highlights

A graceful debut, based on a true story. It’s the turn of the true story. It’s the turn of the century and the world is hurtling towards war. Sharing her father’s passion for medicine and determined to continue his life’s work on heart research, young Agnes White faces society and its prejudices head-on as she strives to become the " rst female medical student. ! is is an upli# ing story of strength, self-belief and following your heart no matter what.

Oneworld PublicationsOut NowISBN 978-1-85168-794-7£8.99 paperback

Robyn Jacobs

Culture Editor

“I’d like theatre to be

as easy as going to

McDonalds”

“If anyone wants to

understand the hu-

man condition or the

human psyche, the

theatre is a really

good place to go”

for audiences today are because of its themes, themes such as city corrup-­tion, social justice, financial regula-­tion, all play really strong parts. And it was the way that argument was put across is what audiences will find par-­ticularly relevant”. Laycock carries on to explain how the play would be rel-­evant for medical students: “If anyone wants to understand the human condi-­tion or the human psyche, the theatre is a really good place to go. The reason why ‘They came to a city’ is particu-­

larly good for that, is because it takes people out of the context of their lives. We all recognize each other because of who we are in the context of our own lives. When we are taken out of that, and other people are aswell, you have to find a way of dealing with that, so the interaction between them all is fascinating to watch, especially for understanding the human problem”.As Laycock explained to me, he and

three others set up the company two years ago, in order to be able to perform their own plays. “We trained at the arts institute of Bournemouth and the course itself had only been going for two years by the time we joined, and we were all very well aware that we weren’t going to have casting agents and direc-­tors knocking down our door to get us into the huge shows, so when we got to London, the two other members, they wrote a play and they asked me to direct it. And we felt that instead of making ‘The New Actors Company’ a vehi-­

cle for this play called ‘The Dinner Par-­ty’, we made ‘The Dinner Party’ as a vehicle for ‘The New Actors Company’ and it’s just kind of gone on from there

really, just trying to promote our own work and the way we work in theatre.” The London theatre scene is one

of the best in the world, and Laycock hopes that in the future, ‘The New Ac-­tors Company’ is going to be on the forefront of London fringe theatre. “We’ve always been really big on high production values. Even if we are in a pub upstairs, we still want people to get the same out of it as if they went to the National or they went to the Wyndham, they should still get the same quality, even if they are paying less money”. He goes on to explain to me how the-­atre should be, and hopefully at one point will be, for everyone, discussing

the problem that people often feel that theatre is removed from their everyday life: “Theatre has always been about talking to people, whether it’s ‘Legal-­ly Blonde’ or whether it’s ‘Oedipus’, it

should always be accessible to every-­one. I don’t think necessarily the prob-­lem is with theatre, I think the problem is because people can watch something on television very easily-­they only need to press a button. Theatre takes a little more effort to go out there. I’d like the-­atre to be as easy as going to McDon-­alds but whether or not we will be able to achieve that, I don’t know, I hope so”.I was lucky enough to be able to see

a small amount of rehearsal before my interview with Laycock. For someone who has spent the last four years of medical school seeing medicine as filler time in between drama shows, the qual-­ity of their rehearsal was astounding. For a show that was still weeks away from opening night, you could already see that it was going to be a great show. I would highly recommend anyone to go and see it before the run finishes.

‘They came to a city’ runs at the Southwark Playhouse from 3rd-28th May. For more info, visit www.newactorscompany.com

DOCTORS’ MESS

The medical profession has many generous upsides, the ability to tend to people’s ailments and aid in their recovery, the ability to research new and exciting treatments for the world’s most deadly conditions, and looking so drop dead gorgeous in that surgical gown and mask that Gok Wan will quite literally melt in a burst of hysterics and mismatched fabrics.

However, with all the long hours strutting your stuff up and down the ward, and all the pints trying to forget the wards when not working, there’s precious little time to find a spouse between ordering a pint of wine and vomiting it up on to the lovely red waistcoat of the toilet attendant. There’s no way you’re getting a lay, let alone a spray.

Other than sinking as low as visiting medicalpassions.com, which is full of desperate 50 something consultants who’ve realised they’ve been sat around dribbling over cardiology textbooks rather than this week’s Zoo centre spread, you could take just a few easy steps and fall flat on your face onto a fine piece of real estate. Or the floor. Or the floor of a fine piece of real estate, but it’s always best to leave the topic of floor fetishes, or indeed any fetish involving household furniture or utensils for quite a long way down the line of courtship. Here’s some classic handy tips of what not to do:

1.) Leave the nurses alone. Let’s be honest, in every (bad) episode of Casualty/Holby City/’That One Where they Merged the Two because the Roof Fell on an Ambulance’, there is always a slutty doctor, and whether the nurse is a more than adequate professional or not; he will proceed to sleep with all of them. Therefore nurses will not want to have this happen to them, because they’re more than capable of remembering that 459 episodes later that nurse got shot by an old man who came in with a small cut on his knee, but ended up being a murdering psychopath, with a terrible case of pseudogout with renal complications. No nurse

wants that comeuppance, let alone yours, so admire them for their hard work, and look elsewhere.

2.) Don’t talk about work. If you’re looking for love but you’re very passionate about your work as an

andrologist, it’s probably not best to approach a dark, handsome man with an offer to inspect his balls for cryptorchidism. He’d probably be quite fond of a ball inspection, however as soon as you start talking medicine, being kicked in the family

By Robert Cleaver

Obs, Gynae & Andrology: Love on the

Frontline of Medicinelove interest. Otherwise you’ll end up urinating on yourself to keep you warm on the cold streets of London hoping a ‘hoodie’ (not as you may expect, a floating piece of warm clothing, but a violent dysfunctional youth’) doesn’t come up to you with a knife and ask you for some kebab money. Skewered.

3.) Splash that cash. The salary has got to come in handy. There’s only so many ornamental candles you can buy your mother, but don’t see that as an excuse to buy an ornamental candle for your potential lover. Get them something really special. A cuddly toy, a CD, a Big Mac with fries, a mcflurry AND a milkshake. Really spoil them.

3.5.) Maybe not the Big Mac, don’t try and fatten them up, they’ll probably throw a fit and make you buy a treadmill, and there’s no way that’ll fit in between the ornamental candles you’ve ordered.

4.) Be confident. I don’t mean running in front of a bus on the M4, or indeed using superglue to style your hair and calling yourself the Fonz, I mean being yourself and chatting to new people. Don’t be as drunk as Mohammed Al Fayed was when he commissioned the MJ statue at Craven Cottage either. Try to remain calm and collected and success will come to you. Unlike Fulham, who’re destined to be as mediocre at football as Ed Miliband was at solving the Curse of the Were-Rabbit.

There are of course many other ways you can impress members of the opposite sex - provocative dancing, dressing in a sleek stylish shoulder dress, drinking 75 snakebites and only vomiting ‘a couple of times’, your ability to go to Ikea and come away with all the pieces of cheap swedish wood that you need to make the fridge of your dreams.

I wish you luck as you go forth and embrace the realm of romance, for love is like introducing a warm feeling into your belly, and after you’ve experienced it, you’re empty and void of pleasure.

Just a bit like life’s enema.

Or an enigma. That word works just as well too.

jewels by Vinnie Jones is actually a far more attractive offer.

2.5.) Don’t start talking about old Mr Patrick’s case of gonorrhoea at any point either. Especially if you’re on the doorstep of a potential new

By Amrutha Sridhar

ANSWERS

Wordsearch

Look for the answers in the next issue!

KenKen

Alcohol has an undeniably huge role in the social lives of the students who indulge in it. It’s not just on nights out either. From “quiet pints” to tours, hockey training, drama rehearsals, student-staff affairs, curries...it’s always there. We laugh it off, but it is bad for you. You’re tired more often, you put on weight, you say things you shouldn’t...And I’m not going to get into a discussion about the people who have 3 pints and decide running home along the train tracks would be the most thrilling thing ever.Before you know it, you’re a few months into the academic year, your life has become a spiral of student mess.

So, having decidedly had enough after one massive absinthe-fuelled emotion-fest, a friend and I went forth to see how we’d fare as teetotallers for two weeks.I really thought it’d be easier than it was. Surely alcohol didn’t have that big an influence on my social life? I’ve always just been a university-based social drinker. I don’t drink with my family, and I usually go every summer without touching a drop. Why should two weeks of teetotalling during termtime be so difficult? I’m a confident person. I shouldn’t need alcohol to enjoy myself.

Admittedly, the first few days weren’t so bad. My liver spent this post-absinthe period cowering in my upper right quadrant, tremulous and sobbing “Please don’t kill me...” (I have a feeling mine wasn’t the only one having a traumatic breakdown). However, Friday night came along, and with it came the urge to socialise. I had the choice between going to the Students Union, or finding something a little drier to do. I got together with teetotal buddy, and we scoured Time Out London for alternatives. We found swingers nights, fetish nights, comedy nights, salsa nights... But they all sounded

crap, so we went to the Union.

Entering the Union as Sober Me was a bizarre combination of frustrating and intimidating. Within minutes my legs and shoes were soaked in snakebite (or just as likely, urine). I’m sure this sort of thing is an ordinary occurrence for Drunk Me, but Sober Me just didn’t like it. Sober Me contemplated smacking someone, banking on the chance that they’d be too inebriated to feel it. Sober Me didn’t feel up to facing the dance floor, as Sober Me has a lower pain tolerance than Drunk me, and there were visibly elbows and stilettos coming from all angles on the floor. I did make conversation with a few friends, but they were pretty trashed and all that was really going through my mind at the time was “Oh my god...You speak so slowly...”. After a close call on the way to the toilets (a projectile spewer on the stairs missed my shoulder by about an inch), I decided my Friday night was over.

The following week the weather was beautiful, which of course gets everyone wanting make the most of the good weather by having a few pints when the sun gets strong. “Morning is over when McDonald’s stops selling breakfast”.So I took in the weather at a big

barbecue on one of the other campuses. From 5 o’clock, everyone was wasted. It was still bright outside, and male friends of mine were stripping off and getting “relaxed” (i.e. “watering the lawn”). I know Drunk Me wouldn’t mind all the gratuitous hugging etc., but as a sober person you become more aware of things like the lump of mayonnaise that was previously streaked across your topless friend’s chest, which is now being pressed into your eye. By a hairy nipple.

The rest of the afternoon was generally pleasant, up until the point when a gaggle of rugby lads decided to attempt some daring acrobatic feats (a double backflip off a human pyramid whilst wielding a lit can of deodorant or something... I wasn’t really watching). One of them landed on me. I mean, it could have been worse. I’m not dead. I’m not seriously injured. I didn’t even really get hurt. But that rage will never die.

I wound up taking a walk off-campus with two other sober friends (they were driving home), to “go to the shop”. After chatting for a while, it was clear that we’d all lost our tolerance for the drunk people and just needed a break. I found comfort in knowing that I was not the only one whose patience was a little drained. Maybe I wasn’t a terrible person...Maybe I was just normal.On the walk back, I passed a local preparing to void his bladder behind an indoor cash machine.

I’m now back to social drinking, but I’ve cut down a lot. I’m actually convinced that the dim lighting in bars helps relieve some of your inhibitions. I am getting less wound up around drunk people, but I’m still struggling to find things to do on a Friday night that really appeal to me. London is built on a drinking culture. If anyone’s interested in starting a Board Games and Diet Coke Society, let me know.

An attempt at sobrietyBy Lorelle Brownlee

A KenKen is like the intelligent cousin of the Sudoku – each row and column is completed with the numbers 1 to 6, and no number should recur in any row or column. Added to this, the numbers in the heavily outlined boxes should combine to give the value in the top left corner, using the specified mathematical operation. Have fun!

Broca Bulb Caudate Chiasm Cortex Medulla Meninges Mesencephalon Nucleus Olfactory Pituitary Supraoptic Tectum Thalamus Ventricle

newsculturefeaturescommentsdoctorsmesssportnewsculturefeaturescommentsdoctorsmesssportnewscommentfeaturesdoctorsmessculturefeaturessportcommentsdoctorsmessfeaturesculturefeaturescommentsdoctorsmessnewsfeaturessportculturefeaturemessculturefeaturessportcommentsdoctorsmessfeaturesculturefeaturescommentsdoulturefeaturescommentsdoctorsmessnewsctorsmessnewsfeaturessportculturefeaturemessculturefeaturessportcommentsdoctorsmessfeaturesculturefeaturescommentsdoctorsmessnewsfeaturessportculturefeatureculturesportfeaturescommentsdoctorsmesnewsculturefeaturescommentsdoctorsmesctorsmessnewsfeaturessportculturefeatureculturesportfeaturescommentsdoctorsmesnewsculturefeaturescommentsdoctorsmessportnewsculturefeaturescommentsdoctor

Join us. editor@medical-student.co.uk

Sportmedicalstudent May 2011 19

Barts created the first move of de-­cency, pushing down the left wing and winning a free hit just outside the scoring ‘D’. Taking it quickly the ball was sent into the D and straight into the back of the net before ICSM could make the clearance. Much to the dis-­may of the prematurely celebrating Barts team, the goal was then disal-­lowed on the basis that it had not trav-­elled five yards before entering the D.

“...sadly there was no cup for ICSM to lift. The previous years winners St Georges had apparently lost the cup, some two years earlier, but did not think it important to tell any of the oth-er medical schools.”

ICSM then started to settle into their game and began dominating possession but were continuingly held at bay by a very solid Barts defence. John Chet-­wood finally broke through to put ICSM in front managing to squeeze a shot through the keeper’s legs from an acute angle. The half time whistle came to the great relief of all the players who were clearly not used to playing in such heat. The second half saw ICSM continue

to hold most of the possession and ter-­ritory. Winning a large amount of short corners, none of which they could con-­vert leaving the score line very narrow. James Arthur was later adjudged to be dick of the day for ICSM because of his inability to score having received the ball in scoring positions from many of these short corners. Bart’s attacks were

limited to breakaways where they used the superior pace of their forwards to rapidly push up the field and threaten the ICSM goal on a couple of nail-­bit-­ing occasions. Like ICSM, Barts found it difficult to convert their short cor-­ners with the pitch being irritatingly slow. This meant the ball often did not make it out of the D, something that is most unusual at this level of Hockey.Just as the players were truly begin-­

ning to flag in the afternoon sun, the final whistle was mercifully blown, leaving the final score 1-­0 to ICSM and crowning them UH Cup Cham-­pions 2011. The winning ICSM team consisted of many final and penulti-­mate year medics who have trained together for up to half a decade, and the final result was a welcome re-­ward for their stamina and cohesion. After the game, both teams and their

supporters shared a pint in the local. It was a fitting end to what was a well spirited but very competitive game. Medals were awarded to members of each team though sadly there was no cup for ICSM to lift. The previous years winners St Georges had apparently lost the cup, some two years earlier, but did not think it important to tell any of the other medical schools. The cup dating back at least thirty years would be a travesty if unrecoverable. Some uncon-­firmed reports coming out of Georges now suggest the cup has been returned to their Union (possibly by some old rugby boys) after a witch hunt, so hope-­fully it can be presented to this year’s winners before next season begins. The cup is sponsored this year

by the MDU, MPS and Wesley-­an Medical Sickness. Without their support it would not be possi-­ble to host this prestigious event . Just out of reach. Barts look for that last minute equaliser. Image by Shrawan Patel

Continued from back page

For the first time since its introduc-­tion in 2004, KCL beat the med-­ics of GKT to lift the Macadam Cup in their annual varsity clash. Up until now the medics have kept

KCL from getting their hands on this im-­pressive piece of silverware but the win eluded them this year at the combined venues of the Berrylands sports ground in New Malden and Honor Oak Park.The Macadam Cup is the premier

sports tournament of the King’s Col-­lege London year, where the men and women of KCL take on the medics of GKT in football, netball, rugby, hockey, darts, fencing, tennis, squash and ulti-­mate Frisbee. The Cup, named in hon-­our of Sir Ivison Macadam, a King’s graduate and founding President of the National Union of Students (NUS), was created as part of a bid to prevent the merger of the GKT sports teams into the KCL clubs during the rebranding of GKT into KCLMS (King’s College London Medical School). The cup itself is a restored St. Thomas’s Rowing Club

champagne bowl which was inscribed with ‘Vicant Optimi’ or ‘The best shall win’ during its transformation into The Macadam Cup. This coveted award is given out to the side that wins the majority of games throughout the day in the various sporting disciplines. The rivalry between the two institu-­

tions has been rising every year since the inaugural Macadam Cup in 2004 and KCL were determined not to head home to the chant of ‘you’ll never win Macadam’ for a seventh year in a row.The day started with the scores al-­

ready at 1-­1 as the water sports had been played the previous day. KCL won the water polo and GKT triumphed in the swimming. So it was still all to play for as the first games of the day kicked off. In the football, the medics played a

match full of incident against the even-­tually victorious KCL team who man-­aged to get a single goal and retain the lead until the final whistle. This came as an early shock to the med-­ics who currently play two leagues

above KCL in the BUCS champion-­ship and also smashed the KCL side 11-­0 in a pre-­season Challenge Cup. The medic women then went on

to show that when it comes to kick-­ing KCL ass at football, girls defi-­nitely do it better. The final score finished at 4-­1 to the medics.The medics didn’t fare so well in the

Ultimate Frisbee losing 13-­8 to King’s in a rather uneventful match where the wind played as big a part hurling the Fris-­bee around the pitch as the players did.KCL’s rugby squad were hoping

to follow up the previous weeks suc-­cesses in the London Varsity match against UCL with a win against the medics but GKT (KCLMS just doesn’t have the same ring to it) had other ide-­as. Charlie West’s team capitalised on the depleted KCL squad and after a confusing round robin of seven-­a-­side matches the medics came out on top. The women’s KCL rugby team had

lost their fixture against UCL the pre-­vious week but turned their team’s for-­

tunes around to beat the medic girls 12-­10 thanks to a last minute converted try. The hockey fixtures took place at

Honor Oak Park and the men’s game ended in a 3-­0 victory to the KCL side. The medic crowds that had gone to watch didn’t remain disappointed for long as the girls smashed the unfor-­tunate King’s side with a comfortable 13-­0 victory. The KCLMS women’s hockey team have enjoyed an extreme-­ly successful year in their BUCS divi-­sion and they didn’t disap-­point today.One of

the final matches of the day was the netball which ended in a nail-­bitingly close KCL victory of 24-­23. There was a tense 30

minutes wait before the KCLSU Vice-­President of Student Activities and Facilities, Kia Alam, announced that KCL had indeed won the 2011 Macad-­

am Cup, winning a total of 7 of the 13 matches that had been played that day. The KCL Netball club, who

were responsible for the thrilling fi-­nal match that put the nail in the GKT coffin, were the first to lift the St Thomas Rowing Club Cham-­pagne bowl on behalf of King’s.As the inscription on the revamped

trophy reads ‘the best shall win’ and for the first time in Macadam Cup history, ‘the best’ weren’t medics .

Two Kings, one cup

May 2011 medicalstudent

Sport

medicalstudent

Barts and the London see red as

ICSM take the UH hockey cup home

This year Barts and the London met ICSM in the final of the United Hospi-­

tals Hockey Cup Final. This match was the culmination of the group games that had been played over the preced-­ing fortnight where all the medical schools played each other and the top two clubs then battled it out for the trophy. The group games ended with ICSM topping the table with three wins and a draw and Barts narrowly get-­

ting through ahead of GKT due to a greater number of goals scored during the group matches, despite being equal on goal difference and overall points. This caused some controversy with GKT wanting to have a playoff. Due to time constraints this was deemed un-­feasible and a precedent has now been set. Next year’s UH committee are go-­

ing to write up rules for the competi-­tion so that this does not happen again. The final took place on a swel-­

tering April Sunday afternoon at GKT’s Honor Oak Park and both teams turned up with a considerable supporting crowd for what proved to be a very entertaining game. The game started tentatively as both

teams came to grips with the occa-­sion, ICSM had not been in a UH fi-­nal since 2006 and Bart’s since 2007. Neither claimed the title on those past occasions being beaten by what was an era-­defining George’s team.

Benjamin FaberGuest Writer

The victorious ICSM squad. Image by Shrawan Patel

ICSM......................1Barts......................0

Continued on page 19

The Macadam Cup:GKT Vs KCL varsityPage 19

Kindly sponsored by

medicalstudent

Page 2-3 Where to travel across the globe; from Norfolk to Norway and Cairo to Cuba.

Page 4For those in London, we have what not to miss in the capital across the summer months!

TRAV

EL S

UM

MER

201

1

VALENCIA

When

In particular around the 19th of March. At this time of the year the weather is beautiful and one of the greatest festivals on Earth takes place: Las Fallas.

Cost

There is no charge to get into the festival as it’s open and in the streets so just normal provisions for souvenirs and the holiday appetite for sweet things.

The festival

The locals have been working hard all year round to produce huge statues out of a wide range of materials that adorn the streets. The statues are of political figures, Disney characters and many more bizarre things. Several of them can be as big as 3 storeys tall! On the 19th of March (St. Joseph’s day) ‘La Crema’ takes place. This incredible event is where the statues are set on fire as thousands of people cram into the streets to watch the blaze. It is a simply fantastic spectacle that has to be seen to be believed. The entire week leading up to ‘La Crema’ is filled with partying and similarly breath-taking sights. So, if you want to experience something absolutely unforgettable, my vote goes to Valencia during ‘Las Fallas’.

BARCELONA

Where

This is a beautiful city located in the Spanish province of Catalonia and combines the city break with beautiful beaches.

Best time to go

As with most of Europe, the best time to go would be between June and August to get the most out of the sun and sand combination!

Healthcare

No vaccinations or immunisations required, but would be good to grab yourself a European Health Insurance Card (EHIC) which allows reduced priced (or even free!) healthcare.

Attractions not to miss

Include La Sagrada Familia (simply breath-taking), Barcelona’s football stadium and the Magic Fountain. The bus tour is an absolute must!

Traditional foods

Include paella, numerous tapas dishes and sangria. Souvenirs

Lots of little souvenirs can be picked up in the large markets or a Barcelona FC t-shirt from one of the shops.

What to do in a typical day

A typical day consists of beach time or shopping during the day and hitting one of the numerous clubs and bars at night.

OSLO

About

This small Nordic city of less than a million inhabitants and limited day-light hours surprisingly has a lot to offer, even when wading knee-deep in snow and visiting during -20 degree celsius temperatures.

Where to visit

The Norsk Folkemuseum is Europe’s largest open-air museum, with indoor exhibits of traditional handicrafts and Sami culture folk costumes. Art aficionados can admire Edvard Munch’s renowned paintings at the Munch-museet (Munch Museum). Take a walk in Vigelandsparken (Vigeland Sculpture Park), one of the most famous Oslo attractions and home to work of sculptor Gustav Vigeland. Visit the Den Norske Opera (The Norwegian National Opera) beside the harbour, the first in the world to let visitors walk on the roof. Before sunset, visit the medieval castle of Akershus festning, offering views of the harbour and a perfect opportunity to capture beautiful dusk photos.

Sports

No visit is complete without a spot of winter sports. instead of skiing, rent a sled and try Korketrekkeren, a full-speed slide down a snow-covered 2000m-long run. At the bottom, catch the metro back up and do it again!

Currency and money saving tips

Remember - Norway is not an EU member, and their currency is the Krone. At the start of your visit, buy the ‘Oslo Pass’, which provides free transport and admission to a multitude of attractions.

ENGLAND

The area

It’s a country in its own right, with flat plains and quirky shores. The people

The people are a strange folk, that’s for sure; they speak in a bizarre dialect that takes years to master.

Average temperature

It can be quite cool, but many summer days are long and can reach dizzy heights of 24 or maybe even 25 degrees.

Culture notes

Most of the locals are illiterate but have impressive skills in farming; I’ll never forget what one local proudly said to me:”I can’t read ‘n I can’t write, but I can drive a tractor”.

Where

So, in short, if you’re looking to discover new, unseen lands, sample a culture that has been untouched by outsiders for hundreds of years and enjoy some of the greatest views the world has to see, then simply head over to Norfolk. You won’t be disappointed.

WALES

Where

Specifically, South Wales. It’s where most of the civilisation is… and Doctor Who! As the capital, Cardiff is the obvious destination but don’t be afraid to venture out to nearby Swansea and Caerphilly too… Newport’s shit.

Event not to miss

If you like to party, Cardiff has the Big Weekend and Mardi Gras in August and September respectively. Alternatively, check out the Big Cheese festival in Caerphilly if you’re partial to the yellow stuff.

Cultural attaction not to miss

Techniquest in Cardiff Bay is a 100% hands-on science museum and is guaranteed to bring out the kid in you. You’re spoilt with castles to visit, including Cardiff, Caerphilly and Castell Coch. For beautiful Welsh countryside and great beaches, the Mumbles and the Gower, just past Swansea, beckon.

Culture notes

I will say one thing. Please try to keep from making jokes about sheep. We’ve heard them all before and they’re not funny. It’s such an ‘English’ thing to do.

CUBA

Currency

Cuban convertible peso (CUC)What to do

Cuba has rich cultural heritage with the sun and sand of the Caribbean. The Partagas cigar factory (Cohiba is the brand you want if you are buying), and Museo de la Revolucion are key sights in the capital. The cays (islands just off Cuba) have pristine beaches and great snorkelling and diving; we visited Cayo Macho, with its population of large iguanas, which was a scene reminiscent of Jurassic Park. If you prefer not to share your sand with reptilian friends, there are other options. Also essential to relive history is a visit to Bahia de cochinos (Bay of Pigs).

Cultural notes

Stay at casas particulares rather than hotels; essentially a guest room in a local’s house, you immerse yourself in Cuban culture, and directly contribute to a local family’s income. However knowing some Spanish is highly useful.

Where to travel this Summer

CROATIA

Currency and average cost per day

Croatian kuna (1 kuna is around 10p) and it’s relatively cheap compared to the rest of Europe!

Places to visit

Croatia’s beautiful coastline is what makes it a must-see. A coast dotted with islands, Hvar is the most popular with students. Spend your days lying on the picturesque beaches, swimming in the warm sea and indulging in the stunning restaurants (all affordable and selling freshly-caught sea food). By night, the sleepy harbour transforms into a buzzing hive of bars catering for all tastes. If all the partying leaves you craving a bit of culture, Dubrovnik is a beautiful coastal medieval town, complete with city walls and a restored apothecary dating from 1317.

Getting around

The trains in Croatia are slow, have the worrying air they may fall off the track at any second and are staffed by the least friendly people in Croatia. However, they are cheap and connect the main cities. Providing you leave enough time to beg a ticket from the attendants, they will get you around! Coaches are a cheaper option, but they get their staff from the same place as the train companies so again, make sure you are clear in where you want to travel to and don’t expect any help from the employees. Getting from the mainland to the popular islands is cheap and easy, many ferry companies operate out of Split, one of the main coastal resorts. Getting between the islands however, can be pricey and may take a few hours. If you plan to see multiple islands during your stay, I suggest a packaged day-trip from one of the tour operators on the main island.

BARCELONA

Where

This is a beautiful city located in the Spanish province of Catalonia and combines the city break with beautiful beaches.

Best time to go

As with most of Europe, the best time to go would be between June and August to get the most out of the sun and sand combination!

Healthcare

No vaccinations or immunisations required, but would be good to grab yourself a European Health Insurance Card (EHIC) which allows reduced priced (or even free!) healthcare.

Attractions not to miss

Include La Sagrada Familia (simply breath-taking), Barcelona’s football stadium and the Magic Fountain. The bus tour is an absolute must!

Traditional foods

Include paella, numerous tapas dishes and sangria. Souvenirs

Lots of little souvenirs can be picked up in the large markets or a Barcelona FC t-shirt from one of the shops.

What to do in a typical day

A typical day consists of beach time or shopping during the day and hitting one of the numerous clubs and bars at night.

VIENNA

Why travel here

Every corner exudes elegance and sophistication, with countless high-baroque churches and imperial palaces to visit, and it is much smaller and easier to navigate than London, both on foot and using the U-bahn (underground).

Places to visit

Located in the central square of Stephansplatz is the gothic Stephansdom cathedral, dominating the Viennese sky-line. Stop at Kapuzinerkirche church to visit the Kaisergruft, a gloomy underground crypt full of ornate tombs, the final resting place of the Hasburg dynasty. Visit the beautiful Hofburg Palace, once housing the Hasburgs and now containing museums, the most rewarding of which is the Schatzkammer, displaying medieval craftsmanship and jewellery. Visit the royal summer residence of Schönbrunn, a perfect example of baroque excess, with beautiful parks and unusual mazes. Take a Fiaker, a horse-drawn carriage, with a bowler-hatted driver and visit Mozarthaus Vienna, the composer’s residence, retaining much of its original furniture and decor. Don’t dodge the folk in 18th-century costumes trying to sell you opera and classical music concert tickets, I greatly enjoyed listening to the world-famous Wiener Mozart Orchestra in the infamous Musikverein Golden Hall.

What not to miss

No visit is complete without relaxing in a traditional street cafe, the most famous is Cafe Central, off Herrengasse. Indulge in traditional Viennese treats like the mouth-watering Sachertorte as you enjoy the beautiful music from the daily piano player.

CAIRO

Why go?

If you are the looking to relax, the Egyptian capital is not the place for you! This bustling, sprawling centuries-old metropolis of never-sleeping streets, never-ending traffic and mish-mash of old and new and rich and poor can be intensely exciting but very stressful, especially when navigating its chaotic roads.

Where to visit

Located in the westernised city centre is Tahrir Square, the epicentre of the recent Egyptian Revolution. It’s full of European colonial-style architecture and art-deco buildings housing small-scale, independent artists’ galleries. Just off Midan Talaat Harb, you can find the once magnificent tea house of Groppi. Another area is Islamic Cairo, starkly different from downtown, with narrow, congested alleyways, old buildings with traditional over-hung latticed balconies, and donkey-drawn carts clobbering down ancient streets. Here, you discover why Cairo is called the ‘city of a thousand minarets’. Don’t miss the Citadel, built by Salah al-Din, the Ayyubid ruler who ousted the Crusaders from Jerusalem, and also its most prominent feature, the Mohamed Ali Mosque, dominating the Cairo skyline with minarets. Well-beaten Cairo tracks include the Pyramids of Giza, the Sphinx, strolling by the Nile at night, and the Cairo Museum.

Traditional food

A traditional, delicious Egyptian dish to try is koshari, although I advise you to try it at a restaurant rather than from a street vendor, only to defer the inevitable bout of ‘Cairo-belly’!

TRIVANDRUM

Where

Thiruvanthapuram, or Trivandrum as it is more conveniently known, is the capital of the Indian state of Kerala, found in the south-west coast of India.

Cultural attraction not to miss

The highlight of the Keralan calendar is probably Onam, the largest festival in the Indian state. Celebrated over ten days starting on 9th September this year, it is a perfect way to experience many aspects of Kerala’s rich culture, including the famous snake boat races and the onam sandya, a sumptuous feast served on banana leaves.

Traditional food

Keralan food reflects its history: it is a mix of indigenous and foreign dishes introduced in the past by visiting traders. My top Keralan dish is the meen (fish) curry. Some of the food comes with the inevitable spice warning, and be prepared to use your fingers to eat!

What to do in a typical day

There is plenty to do in Trivandrum, including enjoying the great beaches in the area. I would highly recommend venturing out to the serene Periyar National Park for a bit of wildlife and nature, as well as spending a day or two on one of the many luxury house boats in Kerala’s backwaters.

Where to travel this Summer

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MAY

The E4 Udderbelly FestivalThe Udderbelly returns to the Southbank this summer to celebrate the best of British entertainment. Included in the comedy line-up are Gina Yashere, Dom Joly & Hardeep Singh Kohli.Admission: From £10

Shrek The MusicalHaving been busy all year with your head buried in books, it’s no surprise that you may have missed out on a lot of great theatre. Brand new to the West End is Shrek The Musical (playing at the Theatre Royal, Drury Lane) starring BGT judge Amanda Holden, Four Lions’ Nigel Lindsay & Choice FM’s Richard Blackwood.Admission: From £20

JUNE

Wimbledon 2011The biggest outdoor tennis event will see greats such as Rafael Nadal, Venus Williams & Andy Murray taking part. Although tickets are sold out, we still recommend you come along to watch from Henman Hill while enjoying a glass of Pimm’s!Admission: Free

Zoo LatesThe London Zoo is once again hosting one of the greatest series of events of the summer fit for all party animals! With plenty of drinks from the various nature-themed bars to a mixture of food menus to compliment all tastes, this is guaranteed to be your wildest highlight of the year.Admission: From £12

CONTRIBUTORS

Travel Writers:Rhys Davies, Jack Harding, Sally Kamaledeen, Katherine

Summer in London:Safa Jahan

London Illustration:Gemma Goodyear

Summer in LondonIn London over summer? Don’t know how to fill the time? Below are a few events we have selected to make sure summer 2011 is one to remember!

JULY

The iTunes FestivalTaking place in the Roundhouse in Camden, this summer promises to be huge with artists such as Adele, Linkin Park & Jessie J already confirmed to perform throughout July.Admission: Free - apply online

Olympic Park TourIn preparation for London 2012, the Olympic Park in Stratford is open for both bus & walking tours right up until the games next year. Book your place early to avoid disappointment.Admission: Bus tours are free, walking tours cost £6

AUGUST

Notting Hill CarnivalSince 1964, the biggest street festival in Europe has taken place every year to celebrate the local West Indian community. Expect three miles of colourful costumes, fitting musical entertainment & deliciously indulgent Caribbean food.Admission: Free

Dinosaurs UnleashedWatch history come alive at The O2 when over 22 enormous animatronic dinosaurs are set free to roam! This uniquely pre-historic adventure is suitable for the whole family.Admission: £12.25 (student)

Kennet, Sanjeev Ramachandran, Anand Ramesh, Zainab Sanusi,

Travel Illustration:Helen Wong

Editor:Robyn Jacobs

SEPTEMBER

London MelaThe O2 hosts a massive celebration of South Asian culture with plenty of singing, dancing & partying. Enjoy the unique sounds of traditional instruments, as well as contemporary Asian musicians.Admission: Free