May 2012The voice of London’s Medical Students

the medicalstudent

Hypochondria - an ill-ness of the mindPage 21

Brains - mind is matterPage 10

London - more than the Olympic cityPage 10

Something on your mindPage 9

Are women the superior sex?Page 8

Medicine from the MidlandsPurvi Patel

Friday 13th April saw medi-cal students from all cor-ners of the United King-dom make their way to the

University of Nottingham for the BMA Medical Students’ Conference.

The day started off with the ex-pected bad luck, as an Imperial del-egate managed to lose his ticket in the five minute walk from the col-lection point to the platform. Promis-ing to meet him at the other end, the rest of the London delegation con-tinued on an uneventful journey to the dreary landscapes of the North.

After checking in and enjoying a complementary finger buffet, del-egates heard opening speeches from the Conference chair, Nick Dea-con, and the BMA MSC Co-Chairs, Marion Matheson and Elly Pila-vachi. Following this, delegates at-

tended one of five workshops. The keynote speaker, Dr Clare Ger-

ada, Chair of Council of Royal College of General Practitioners, emphasised the importance of a good doctor-pa-tient relationship. She reminded eve-ryone present to be kind to their pa-tients - and encouraged them to be GPs.

A brief accountability session al-lowed delegates to follow up motions passed as policy last year, and hold the MSC Co-chairs to account for their year’s work. Several delegates expressed their dissatisfaction with the work done on their policies, and the principal reason for this seemed to be the lack of time the MSC Co-Chairs were able to devote to these.

And then the motions began. Each university could submit up to six mo-tions, three of which can be submit-ted as priority motions. At least one motion from each university would be discussed in the first part of the

agenda, and of the rest, five motions would be selected for discussion in the second part of the agenda. Al-though the majority of these motions passed smoothly, others were met with a surprising amount of resistance.

One motion, submitted by Queen’s University Belfast, deplored the deci-sion under the new Foundation Program Application Scheme to give credit to graduates from the Universities of Not-tingham and Southampton for BMed-Sci degrees obtained during the normal course of study. This was met with con-siderable opposition from the respec-tive institutions, who insisted that their additional degrees were the result of longer hours and a more difficult cur-riculum. Unfortunately, this argument did nothing to convince the rest of con-ference, and the motion was carried, much to the despair of the delegates from Southampton and Nottingham.

After lengthy discussion of

nine motions, and the promise of at least 25 more on Saturday, it was time for the day to come to a close.

The theme of the night’s enter-tainment was ‘black tie with a hint of Bollywood’ which, as the title sug-gests, led to a variety of interesting outfits. Delegates were treated to a three course Indian meal, followed by a Bollywood dancing lesson. Under-standably, there was a direct correla-tion between the volume of alcohol consumed and the willingness to take part in the evening’s activities. While the night officially ended there, some of Nottingham’s finest clubs may have been bombarded with students later on.

The late start of 9.30am on Sat-urday was deemed far too early by those who most enjoyed the previ-ous evening’s festivities, but they turned up regardless, to celebrate Dr Hamish Meldrum’s birthday.

(cont’d on page 2)

News Editor: Ken Wunews@medical-student.co.uk

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News May 2012 medicalstudent

Exams are the main topic of conver-sation at GKT as the first, second and intercalating year students sweat over their end of year exams, and the final years boldly take on their finals (for which we all wish them the very best of luck). Even the fourth years have some exam stress as everyone seems to say it’s harder than their year. We shall soon find out. Only the fifth years are enjoy-ing themselves at the moment having just finished their in course OSCEs and are currently 'attending' the Pathol-ogy Therapeutics Block by going to Borough's excellent selection of pubs.

MedSoc have just held their com-mittee elections, and it is my pleasure to congratulate my successor, Dheeraj Kh-iatani, to the role of MedSoc President for 2012-2013. In other news, everyone survived Ski Tour, the subcommittee elections are coming up, and everyone

is keenly awaiting the Summer Ball.Having been stung in the last paper

by our perverted editor, I have chosen to be mature this time and not write about anyone on these pages. Except Nana and George, who never write an-ything remotely interesting, and Suzie, because I am obliged by age old rival-ries and she disagrees with my keen sense of fashion. If Jeeves Wijesu-riya has mentioned me in his column again, then I am going to file for a restraining order, and sue for libel .

M Alexander ShimmingsGKT Medsoc President

Nana AduSGUL President

George RyanBL President

Editor-in-ChiefPurvi Patel on exams, elections and editors

Find us on Facebook and Twitter@msnewspapermedicalstudent newspaper

Editor-in-chief: Purvi Patel News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Kiranjeet Gill Doctors’ Mess editor: Rob Cleaver Image editor: Chetan Khatri Social Media editor: James Turbett Sub-editors: Alex Isted, Keerthini Muthuswamy, Ashik Amlani Distribution officer: Sanchit Kapoor Consultant editor: John Hardie

Contact us by emailing editor@medical-student.co.uk or visit our website at www.medical-student.co.uk

themedicalstudent

The world of George’s is starting to wind down towards exams. Congratu-lations to all of our finalists who have battled for five long years and are now free to enjoy their electives. To every-one else, good luck and if possible pur-chase a rock, then place yourself under it. In the SU world, both elections and awards evening are on the horizon. Elections are basically where most of the exec team and I breathe a massive sigh of relief - because the SU is still standing for another year, and retire from our roles. This follows the demo-cratic process of campaigns, voting and a very very long count - or in Shim-mings case, late nights spent stuffing the ballot boxes and crying because no one would vote for him. We are incred-

ibly excited to see the fresh and fantastic ideas the candidates have for next year.

Banter aside, I personally had the pleasure of representing SGUL at this year’s NUS conference in Sheffield, es-pecially because we are a real students’ union (sorry, couldn’t help myself). Some impressive debates raged on, and we yet again represented our students and fought over the issues that matter to you. Don’t forget, despite everything going on, we are still preparing for this year’s bigger and better Summer Ball .

And here we are: the final Medical Student of this academic year. May has been relatively quiet, with everyone working hard for exams and such. Of course, some of us have been working hard for other reasons, including fight-ing both for the life of this newspaper, as well as the ongoing battle with BUCS.

One would think that after last month’s debacle, the Presidents of the London medical schools (and MedSoc) would have learnt their lessons, but this is clearly not the case. At least this time they are taking shots at each other, al-though our unfortunate Mr Wijesuriya is still having trouble with his spelling.

Despite this, they have managed to find a common ground – this time the target is not as innocent as the Editor-in-Chief of the Medical Student, but the

more real threat of BUCS. The students of London continue to oppose the pro-posed merger, despite being misrepre-sented at every opportunity, and instead of throwing a tantrum about how un-fair life is Medgroup has been surpris-ingly efficient at confronting the issue.

Some SU elections have already taken place and others are imminent so, jokes aside, I would like to take this op-portunity to congratulate the presidents on a great year, and wish their succes-sors all the best for the one to come.

On that note, the Medical Student team is losing some of its most val-ued staff. We say goodbye to our ca-pricious News editor, our ever-pre-pared Features editor, and our most faithful Comment editor. We are, as ever, lacking a treasurer and a Sports

editor. Of course, this means there is more room for you! For information about any of these roles, or to apply, email editor@medical-student.co.uk

Have a great sum-mer, see you in September! .

The contractors working on the GriffInn have been keeping to their deadlines as well as a patient in atrial fibrillation keeps a regular heart rate but I can assure you that it is coming along very nicely. With the new open-ing date set for the week of the 11th June, the new bar will be completely unrecognisable in comparison to what we left behind in October. Prepare yourselves for brightly coloured walls, comfortable furniture and a fully func-tioning kitchen that has the potential to serve anything from a grilled burger to roast dinner. Did I mention we’ll be serving Starbucks Coffee as well?

On a more serious note, the hot top-ic at BLSA this term has been ‘should BLSA remain a-political and a-reli-gious’ and therefore continue to not allow religious and political societies to affiliate? The students union is dif-ferent for every student. For some it’s a drinking hole, some a way of rais-

ing money for charity and others a way to develop ones CV. The principle we must stand by is that the Students As-sociation is flexible enough to be what-ever its current body of students need it to be. It is vital in this day and age that we accept and engage with those that unite as part of a religion or political opinion. Those students are equally as proud of being a part of BLSA as any of us are. The debate went very well and I’m proud to say we removed the entire clause from our constitution. I hope this is a step towards engaging all of our students under the umbrella of BLSA .

The night’s activities were called into question by Sheffield’s motion con-cerning the large volumes of alcohol consumed by medical students. It called for the MSC to: support a realistic minimum pricing on alcohol, increase awareness among medical students of the harmful effects of binge drinking, oppose the active advertisement of re-duced alcohol prices used by medical societies, and to work alongside medi-cal societies to reduce their focus on ex-cessive alcohol consumption and cater for the needs of those students who do not wish to engage in binge drinking.

This motion was the most contro-versial of the conference, with many delegates speaking both for and against this motion. It sparked great debate amongst students, with the chair hav-ing to call for a vote despite numerous delegates’ wish for more discussion. Conference was divided on this issue, as was the London delegation, but the majority voted in favour and the mo-tion was passed as policy for next year.

London was, as always, well rep-

resented – with the exception of St George’s, who expressed their disin-terest in student politics by sending a single representative, and submitting no motions. Imperial’s primary mo-tion was asking for an NHS database anonymising patient information for use in research, whereas GKT’s mo-tion was concerned with addressing the stigma attached to students who fail medical school finals on the first attempt. One particularly boisterous Oxford student decided to speak in Latin, against this motion, for which he was duly heckled by the London delegation. Barts took the BUCS issue to conference, asking the BMA MSC to join the campaign against the pro-posal merging medic and non-medic sports teams. UCL had a more altru-istic approach, and were concerned with reducing health inequalities – the motion that MSC Co-chair Elly Pilavachi declared as her favourite.

The topics covered by the motions spanned a huge variety, showing the passion students can have for politi-

cal issues. The motions brought to conference also show the priorities of different institutions. As a member of the London delegation, and prominent member of UH MedGroup remarked, ‘Manchester brings issues such as sex-ual assault and global health, where-as London is all about FPAS, exams, and sport – we’d never touch a global health issue’. This, while not com-pletely true - as shown by the motion submitted by UCL - is a fairly accu-rate description of the London medi-cal schools. It may be due to having so many medical schools in such close proximity, but from day one of medi-cal school, students are aware of the immense competition they face, and this is reflected on a national level.

Either way, the weekend was a great success: the MSC policy for the next year has been formed, and the new team elected. The coming year will be crucial in deciding the fu-ture of this country and as Dr Ham-ish Meldrum said, ‘we must never stop thinking we can fight every battle.’ .

3medicalstudent May 2012

NewsNeil ChowdhuryRUMS President

Suzie RaynerICSM President

Here comes the end of my tenure as RUMS President - and RUMS has re-mained ever better than our less than carbon-copies. RUMS won the UH cup in Rugby this year, annihilating any competition we have, and our Sports Ball has been the most successful to date and even equalling in size to our non-medic counterpart’s Sports Ball. This is a true testament of how impor-tant our teams are to RUMS, and in-deed medical students. We have also taken our kit off for charity and made our signature naked playing cards, which are selling very successfully.

RUMS could be the only one ever to set the trend for other medical schools, not follow them. We are also about to have our first Sports Tour coming to London. Brighton and Sussex Medical School wanted to hold a tour and natu-rally went for the most gifted, clever,

and fun teams in the whole of London. Finally, the Finalist Ball preparations are under way, which is held within the Tower of London’s pavilion this year. The finalists will be able to celebrate within the moat of London's most icon-ic building. I want to say thank you co-presidents of Medgroup – it’s been a good ride this year, and the banter has been epic. I'm sure the power of the five med schools shall live on - un-til RUMS takes over Barts and I hope it lives on for the rest of our days .

So we have reached the last Medical Student this year - how very sad. My thanks go to The Medical Student’s newspaper team for their great work this year, and to all at ICSM – espe-cially the ICSMSU Exec, who I have had the pleasure of working closely with. And the other med school presi-dents have been alright sometimes too.

It felt appropriate to give some words of wisdom to the incoming presidents, about who gets given the role and some of the perks. To be-come president of GKT, you should have an avid interest in sport and gin, as well as preferably having a name that rhymes with a niche sexual prac-tise. Barts Presidents are often the best looking of the bunch, but beware, the year of presidency may enlighten you to the wonder of the intercalated year at Imperial and cause you to leave the

beloved Barts and join our ranks for a year. My advice to St George’s Presi-dent also rings true for Barts – if you manage to get your predecessors to stop interfering in your current activi-ties, then you have achieved more than this cohort. At RUMS, apparently the only way to become President is to be Gareth Chan. And the perks of being ICSM President? Well, being President makes you a great hit with the ladies .

You find us at a very exciting time at Medgroup. As we continue in our bat-tle with BUCS we are excited to an-nounce that we now have the support of the RFU and the BMA! We have also been assured of the personal sup-port of Hamish Meldrum and Steve Hajioff, Chairman and Vice-Chairman of BMA council respectively. We are now responding to BUCS once again as the collective force of all five Lon-don Medical Schools, Cardiff Medi-cal School and ULU before their AGM with our criticisms of their cur-rent proposals and our own solutions. We are also almost able to launch our new website and the Pan - London mental health survey. These are defi-nitely exciting times for Medgroup!

In other news, each of the London Presidents have been severely rep-

rimanded by Medical Student Edi-tor Poorvi following our recent com-ments about her lascivious behaviour and we would like to take this op-portunity to apologise for our com-ments which (though truthful), were made frivolously after a night on the tiles. We promise not to go after Poorvi again, for now. Mark Shim-mings, however, remains fair game .

Jeeves WijesuriyaUH President

Rhys DaviesComment Editor

For any student involved in sport at medical school, BUCS has become a bad word.At their AGM last summer, BUCS tabled for discussion the ‘his-torical anomaly’ of medical school sports teams, separate and distinct from those of their parent universi-ties. It seemed ludicrous that the same university should have to compete against themselves in the same league.

However, this fails to take into ac-count the independent nature and ori-gins of many medical schools in the UK today. As such, many medical stu-dents, including MedGroup, were out-raged that their beloved sports teams might face dissolution. In many univer-sities, the medical teams play in a high-er league than their parent university equivalents. This honour and prestige, for the medical schools and their uni-versities, would be lost in the disband-ment. The suggestion that the most able medical sportsmen and women can simply join the main university team fails to take into account the differ-ences in schedules and commitments

between medical and non-medical stu-dents. Many university sports teams train and practice on days and times that medical students, due to course commitments, simply cannot make.

MedGroup wrote an open letter to BUCS, detailing their objections to the proposals, as well to the London medi-cal school student unions and sports committees. This developed into a peti-tion signed by more than 2500 students. BUCS responded by saying they would enter into a consultation period, consid-ering the best way to resolve the issue.

During this period, Medgroup and others have redoubled their efforts, restating their complaints. However, the London representatives to BUCS, opposed to the medical teams’ con-tinued autonomy and participation, have attempted to downplay the op-position’s existence or relevance.

Some medical schools, meanwhile, have attempted to find their own solu-tions. Both Imperial and RUMS have proposed that medical and non- medi-cal teams share administrative titles only and remain ideologically sepa-rate. However, this is still not without its problems. BUCS has remained si-lent on the issue and have yet to hold

a meeting open to all parties involved.In the face of BUCS’ continuing

silence, MedGroup have been gather-ing support from larger institutions. Cardiff University School of Medi-cine, also potentially affected by the BUCS proposals, have pledged their support, as have ULU president Vraj Domalip and UH staff president Pro-fessor Sir Nick Wright. Recently, they have gained the support of the Rugby Football Union. They have also re-cently gained the unanimous support of the BMA Medical Students Com-mittee and have the personal backing of BMA Council Chair Dr Hamish Meldrum and Dr Steve Hajioff, Chair of the BMA’s representative body.

Now MedGroup are demanding a meeting with BUCS where the affected parties can gather and have their ques-tions answered. The volume of sup-port that they have gathered within the space of nine months is testament to the strength of feeling against these pro-posals. Hopefully, BUCS will listen to their criticisms and alter or drop their plans against the medical sports teams.

However, with time pressing on, BUCS will need to reach a deci-sion, one way or another, soon .

The Battle with BUCS

Victory will be ours!

4

News

It is my last day as an F1 and I am staring at my replacement in disbelief. Did I really look like that? He has a crease free shirt,

slicked back hair and no bags under his eyes. My envy for his fresh looks is soon overtaken by trepidation for him as I remember what it was like being in his shoes 364 days ago. Politicians say a week is a long time in politics - they should try a year as a doctor!

My fellow F1s and I have all trans-formed from wet behind the ears re-cruits into fully fledged battle hard-ened veterans. I try to scour my brain for some pearls of wisdom for my fresh faced replacement and be-ing such a jolly nice fellow I am de-ciding to share them with you now.

Number 1: Don’t bullshit. As my SHO said to me, no one minds a shit F1, but everyone hates an F1 who lies (he was not referring to me I hasten to add). If you do not know something just say. You are now an adult and you are no longer try-ing to blag your way through exams.

People will expect you to know nothing and not be able to keep track of everything and they will not begrudge you for that, but if you start bullshit-ting to cover your back you will be found out and then everyone will dou-ble check your work and you will be-come ‘that guy’. Don’t be ‘that guy’

Number 2: Do not bullshit – no, se-riously I mean it. Just don't ever do it.

Number. 3: Lists. Picture the scene: busy post take ward round, muggins here holding mountains of notes whilst trying to write in all of them as con-sultant whizzes through patients, un-til a helpful nurse points out that we have actually missed out a patient who is sitting right in front of us. Consult-ant looks at the patient then to me then back to the patient and says ‘but they are not on the list’ in a way to suggest that they do not really exist.

It may sound ridiculous but pa-tients who are not on the list do not exist. This word which should be as-sociated with such menial things like grocery shopping takes on a whole new meaning within the hospital.

"Forget doctors, nurses, and even money. These things do not make a hospi-tal work but rather it is these tiny pieces of parchment that hold the key to a pa-tient’s wellbeing."

Without them consultants won’t know where to go, people won’t be booked into theatre slots, and

jobs won’t get done. Unfortunate-ly the F1 is responsible for keeping these all up to date. No one will say thank you for keeping the list up to date but they will definitely let you know their displeasure if it is not.

Number 4: Play nice, especial-ly to the nurses. On a busy on-call shift, one senior nurse says to me ‘I don’t feel happy about that guy’. All their observations are normal, but 12 hours later, that patient was dead.

"Once I finish re-counting my trials to my replacement he stares at me speech-less with his mouth slightly ajar like a goldfish as the enor-mity of what is about to occur hits him"

There will be days when you feel that nurses have been placed on this earth for the sole purpose of annoying you but in reality they can make your life so much easier. Just remember they have been in the game much longer than you and are often much more ex-perienced than you. If they are worried about a patient, take it seriously and re-member they know how things work. It is their ward you are working on so do things the way they want it done and your life will be more bearable.

Number 5: Ask for help. There will be days when you feel as if you have turned into Atlas in quick-sand as the weight of the world is on your shoulders and you steadily sink into the depths of the cesspool that is the inner workings of a hospital.

However, remember that there are always people to ask for help and you should never feel like you can’t ask for it. If your seniors are an-noyed by you for asking for help - screw it: that is what they are paid for. Most of them are also really nice and remember what it was like.

Worst of all, if you are an-noyed by yourself for asking for help, get over it - don’t let a patient’s care be compromised by your ego.

Number 6: Enjoy it. There will be times when you cry in toilets dur-ing on-call shifts. There will be times that you wake up terrified as you think you have done something wrong. There will be times when you will think why the hell did I sign up to this, but just remember that you truly have the best job in the world.

The colleagues you meet and work with will be so full of character it will seem like they should be in mov-

ies and you will share moments with them that range from the truly ter-rifying to the sublimely ridiculous.

"Politicians say a week is a long time in politics - they should try a year as a doctor!"

Never forget that you are in a most privileged position and peo-

ple you have barely met will en-trust their lives into your hands, and that is why you signed up to it.

Once I finish recounting my tri-als to my replacement he stares at me speechless with his mouth slightly ajar like a goldfish as the enormity of what is about to occur hits him. Then I am filled with a strange feeling - al-though it has been tough and gruelling, I am strangely envious of him. Then it dawns on me I am going to miss it. I am

Diary of an FY1Junaid Fukuta shares his pearls of wisdom on his last day as a FY1

actually going to miss it, warts and all. All I can say before I leave is: good

luck, and the same goes to all of you .Junaid Fukuta has been writing the Diary of an FY1 for the past two years. Junaid graduated from Imperial College School of Medicine in 2010. He went on to work in the Bristol Royal Infirmary and is currently applying for his CT1 job.

May 2012 medicalstudent

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News

Comment Editor Rhys Davies

Features Editor Bibek Das News Editor Ken Wu

the medicalstudent is recruiting

Hello. My name is Rhys Davies and I want you to take my job!Of all the sections, Comment has the most freedom

in terms of content (apart from Doctors’ Mess). Each month, I am surprised by the diverse topics medical stu-dents in London choose to write about. No other section puts shisha, evolution and white coats on the same page.

Then there’s the Head-to-Head. You can pitch the big issues of the day to all the medical students in London and hear their arguments come flying back.

If you do this job right, people won’t know you’ve done anything at all. There’s a certain pride in that. Comment lets the medical students speak, and you could be the one giving them the soapbox!

Being Features Editor is the best job on the pa-per - not as stressful as Chief, but with enough time on your hands to carefully plan your section.

You need to be organised and have an eye for detail as you scour thousands of words for tiny mistakes, but you should also be able to recognise your writers' strengths and weak-nesses and provide encouragement and critical feedback.

For the large part, you get to set the agenda each month, which involves suggesting topics that provide analysis and insight into the fascinating issues that af-fect medical students - ranging from professional de-velopment, to relationships/lifestyle and global health.

News editor of The Medical Student. Sounds awesome right? It’s actually one of the best jobs you can have on a student publication.

The perks include harassing anyone you can, whether if it’s the BBC, Deans of the medical school or the SU president, to get information you need. You also get to be part of an amazing editorial team with their unique take on medical school banter, as well as ordering them to do whatever you need.

Let’s face it, after the editor-in-chief, you are the most important person on the editorial team.

For more information email editor.medicalstudent@gmail.comDeadline is May 31st

medicalstudent May 2012

FeaturesFeatures Editor: Bibek Dasfeatures@medical-student.co.uk

May 2012 medicalstudent6

Do Women Make Better Doctors?With the majority of medical students now being female, what does this mean for the future of healthcare?

Alexander Isted explores the issues surrounding an increasingly female dominated medical profession

Women have for centuries, been absent from the pages of medical history in a field so dominated

by men. 1874 introduced the first medi-cal school with a female intake, known as the London School of Medicine for Women as part of the Royal Free. It wasn’t until a report in 1943, criticis-ing the low numbers of female doctors that other medical schools followed suit with the aim of reaching levels of 20% female medics. Over the next

sixty years, mind-sets changed and in-stitutional sexism began to fizzle out, with the proportion of both female ap-plicants and acceptances creeping up, even surpassing those of male medics around the millennium. With the trend set to continue, women doctors are due to outnumber men within a decade.

It is clear that the typical doctor demographic has changed radical-ly in the last half century. For many years, girls have outperformed boys in GCSEs and A levels, giving them

the tools for a stronger medical appli-cation, so weighted on academia. In an interesting shift in social trends, the old image of a typical doctor as white and male is conversely one of the social groups that now undera-chieves most in secondary education.

Despite the fact that women are soon to be dominating in sheer num-bers, they are by no means equally represented across all specialities. Surgery, which has always been infa-mously male dominant, does not have

an increasing female representation nearly as much as such fields as gen-eral practice, palliative care and pae-diatrics. Whether this is a relic of the old era of male only surgeons, soon to be ironed out as the older, more tradi-tional consultants retire, or whether surgery simply appeals less to women, is unclear. Women certainly have more of a burden of having to factor in the time required to have a family, than men do. In a survey of female medi-cal students and junior doctors, 90%

said that they were concerned about the difficulty of balancing the raising of a family with their medical careers.

The media has mapped the in-crease in numbers of female doc-tors like the trend of a pandem-ic, but are women better equipped to make a good doctor than men?

The measure of what makes a good doctor seems to vary amongst the beholder. Patients value per-sonal attributes as empathy, com-munication skills and compassion.

Image by Chetan Khatri

medicalstudent May 2011 7

Features

“The media has mapped the increase in numbers of female doctors like the trend of a pandemic, but are women better equipped to make a good doctor than men?”

Stereotypes certainly suggest that women are better communicators than men, a study in Scandinavia going as far to say that this is true on a biological level. The study concluded that women have an innate ability to subtly mim-ic the expressions and idiosyncrasies of whoever they are conversing with, through the action of ‘mirroring neu-rones’, and thereby show a better sense of empathy. Another study concluded that men interpret social interactions with more rational and logical meth-odology compared with women who can more easily put themselves into the shoes of whoever they are talking to, allowing them to better relate to them. Even the term ‘maternal’ itself conjures more images of what a doctor should be than the term ‘paternal’. Whilst the

father figure guides and can provide instruction and can instil confidence, the mother can communicate and read feelings, allowing you to be vulnerable.

Perhaps these stereotypes exist, but do general gender differences ac-tually exist in the medical profes-sion? It has been found that female doctors utilise psychosocial ques-tioning methods and shared deci-sion-making in consultations 10% more than their male counterparts.

“In certain fields, particularly obstet-rics and gynaecology, women are favoured by the majority of patients regardless of whether the doc-tors have stronger or weaker skills in empathy and communication.”

In certain fields, particularly ob-stetrics and gynaecology, women are favoured by the majority of patients regardless of whether the doctors have stronger or weaker skills in empathy and communication. This is understandable

and often applies conversely for male patients undergoing physical exams, preferring male doctors. Many who have strong religious observations also feel more comfortable with a certain gender, and this is unlikely to change.

Fellow doctors and medical staff value medical competence and the ability to work in a team with cama-raderie. This is solely based on the individual’s traits, as the aptitude of graduating doctors doesn’t have any significant gender difference with the academic girl/boy divide having closed by completion of the medical degree. Paradoxically admissions staff at medical schools, appear to value aptitude in chemistry, which (with the exception of graduate entry appli-cants) is better performed by female applicants. This highlights a different issue of whether the university admis-sions process has its priorities right.

“Fellow doctors and medical staff value medical competence and the ability to work in a team with camaraderie.”

In a survey of medical students, the trait they prized most amongst their fellow medics, who they will one day work with, was cheerfulness, a trait which is clearly not gender-specific. It can hardly be argued that the process of medical school is designed to weed out anyone who would become a ‘bad’ doc-tor on the grounds of their knowledge, clinical aptitude and drive. Beyond that, the factors that can vary between doctors are an individual’s ideosyn-crasies and personality that they bring to the team and ultimately to their pa-tients. Being a pleasant, engaging, ex-trovert may not make you a better doc-tor in the exam halls but it will on the wards, both for collegues and patients. Critically, gender has no effect on this, so in the eyes of other medical students, at least, women don’t make better doc-tors, not do they make worse doctors.

An interesting question to pose is ‘do women make safer doctors?’ It is widely agreed that women make safer and less reckless drivers. After years of say, surgery, the act of perform-ing a hip replacement may become as frequent and mundane as the drive to work, so will the traits which make men more dangerous on the roads

make them more dangerous in the op-erating theatre? Proportionally, more medical negligence litigations are made towards men but this is mir-rored by the fact that men ocupy more of the roles which are likely to to have negative outcomes such as surgery and anaesthesia. On an individual level, there is no evidence to suggest that women make safer doctors than men.

“Being a pleasant, engaging, extrovert may not make you a better doctor in the exam halls but it will on the wards, both for collegues and patients.”

The quality of the patient experience seems, critically, to be based on how comfortable, reassured, involved and informed the they are made to feel. The very terms ‘maternal’ and ‘paternal’ are increasingly outdated and gender traits should be taken out of the equation. Ultimately, these trends must be taken with a pinch of salt, as the quality of a doctor is not pre-determined by their gender, but their individual qualities .

Image by Yuan Cao Xue

medicalstudent

This Summer in LondonAsk not what you can do for London, but what London can do for you

WimbledonJune 25 - July 8 All England Lawn Tennis Club

The oldest and, arguably, the most prestigious tournament in the world, Wimbledon is the only major grand-slam tournament still to be played on grass courts. Get there early for reasonably priced tickets on centre court and watch some of the top names in tennis battle it out. Alternatively, enjoy the view from Henman Hill with the traditional strawberries and cream.

Festival of the WorldJune 1 - Sept 9 Southbank Centre

An urban beach with a twist, the largest ever UK poetry festival and the chance to work with and learn from the world’s leading artists – this festival has it all.There will be many opportunities to get stuck in and take part, plus art, music, comedy, markets and free events to enjoy.

BBC Proms 2012July 13 - Sept 8 Royal Albert Hall

This year's BBC Proms are part of the Cultural Olympiad 2012, a four-year programme of cultural events leading up to the Olympic and Paralympic Games. Reflecting London's momentous year on the global stage, the 2012 BBC Proms programme is packed with world premieres, beloved classics and internationally renowned musicians.

Notting Hill Carnival 2012Aug 26-27 Notting Hill

The most fabulous event of the summer is back and this time it's big-ger than ever. This vivid celebration of music, movement and masquer-ade is buoyed by stalls loaded with delicious Carribean foods such as jerk chicken and fried plantains. If you want to join the party, be aware that Ladbroke Grove station will be closed on both the Sunday and the Monday.

London Mela 2012Aug 19 Gunnersbury Park

This one day festival is celebration of everything London's Asian com-munities have to offer. Representing both classical and contemporary Asian culture, the event also features art, dance and comedy.

A Midsummer Night's DreamJune 2 - Aug 12 Regent's Park Open Air Theatre

Set in the leafy environs of Regent's Park, this Shakespearean classic mixes comedy and romance, with some magic added in for good meas-ure. Fairie queens falling for donkeys - anything can happen in this magical, mystical world.

SuperhumanJuly 19 - Oct 16 Wellcome Collection

Incorporating a wide range of different perspectives, from the athlete to the fictional superhero, this exhibition will ex-plore how human ability has been enhanced in the past, con-temporary approaches to the subject and what those working at the forefront of human enhancement anticipate for the future.

medicalstudent

This Summer in LondonAsk not what you can do for London, but what London can do for you

London Literature FestivalJuly 3-15 Southbank Centre

This festival brings together international, world class poets, au-thors and speakers representing the spectrum of creative disci-plines for more than a week of talks and events. The line-up is yet to be announced, but previous highlights have included Iain Sinclair, Alan Hollinghurst, Zaha Hadid and Philip Pullman.

Festival of the WorldJune 1 - Sept 9 Southbank Centre

An urban beach with a twist, the largest ever UK poetry festival and the chance to work with and learn from the world’s leading artists – this festival has it all.There will be many opportunities to get stuck in and take part, plus art, music, comedy, markets and free events to enjoy.

SuperhumanJuly 19 - Oct 16 Wellcome Collection

Incorporating a wide range of different perspectives, from the athlete to the fictional superhero, this exhibition will ex-plore how human ability has been enhanced in the past, con-temporary approaches to the subject and what those working at the forefront of human enhancement anticipate for the future.

ColdplayJune 1-2 Emirates Stadium

Galaxy-conquering popsters hit the most mahoosive of enormo-domes, playing principally from their latest album, 'Mylo Xy-loto', which adds experimental R&B and electronica to their uplifting and grand-scale, well-crafted alterno pop/rock, with-out sacrificing any of their crowd-pleasing big-heartedness.

London 2012 Olympic GamesJuly 27 - Aug 12 & Aug 29 - Sept 9

The world comes to visit, as the east end of London is turned into a haven of athletics and sports stars. The olypmics kicks off with football, followed by the paralympics two weeks later. If you haven't got tickets for any of the events, and aren't taking part, we suggest you avoid this area like the plague. No, really.

10

CommentComment Editor: Rhys Daviescomment@medical-student.co.uk

May 2012 medicalstudent

Last week, I handed in my first year student selected compo-nent. At George's, that equates to 1250 words on a hot topic

question chosen from a list of options. I chose to answer whether depression is an over-diagnosed modern day dis-order. I thought it would be fun taking on a philosophical, historical question over some boring statistical one. And I quickly discovered that 1250 words are by no means enough to answer said question. Depression’s history is one of intense complexity, harrowing in-stability, and inescapable confusion.

"Less is understood about the brain and/or the mind than anything else in the universe. All the other body systems are limp-wristed side characters compared the real star of the show, conscious thought. "

One of the points I managed to make was that depression's definition is inevitably manipulated by consumer capitalist pharmaceuticals companies, and how for a brief time, most mental diseases were solely defined as by be-ing made better by Prozac, which was obviously no good thing. But that aside for now, my main argument was that depression, thought, and the mind in general are so complex and misunder-stood, that it would be impossible to not correctly encapsulate what it is to be depressed, and this would ultimately lead to many not knowing whether they were depressed or not. After finish-ing the essay, I am left thinking about what it might take to truly understand what depression is, and so, I find my-self back in the fiery, cognitively closed pits of philosophy of the mind.

"We generate dopa-mine when we sleep to re-sensitise our neurones, but why does this make us feel more awake? I'm not talking about physiology, I'm talk-ing about the red-ness of red, and the sadness of sadness. Or am I?"

Let us be honest here. We have no idea why we sleep. We don't know when the almost instantaneous exchange of potassium for sodium across a myeli-nated membrane becomes a thought. We don't know why we make pictures in our head that seem to have location even though they don't. And ultimately we have no idea what consciousness is.

Less is understood about the brain and/or the mind than anything else in the universe. All the other body systems are limp-wristed side characters com-pared the real star of the show, con-scious thought.

After studying the philosophy of the mind, I picked eliminative materialism as my camp. It might be best to divide the school in two to explain it. The first point is that concepts like conscious-ness, the soul, and the qualitative na-

ture of experience will not, and cannot, be reduced by modern science. This is appealing, isn't it? We understand so much about the universe, but so little about our minds. If I were going to be arrogant, I could say, ‘If we still don't understand the mind, there might be something wrong with what we're try-ing to understand.’ The second con-cept in eliminative materialism is that as the nature of consciousness cannot

The Matter of MindRobert Vaughan peels apart the nature of consciousness

be reduced, it must be eliminated. In the 1800s, we spoke of illness as

the action of evil spirits upon the body. The reason we can't logically apply evil spirits to medicine is because evil spirits do not exist, and as medicine came into play, the idea of witchcraft and phantoms became so obviously in-correct that we banished them entirely from the field of medicine, and I wager that sooner or later the same is to hap-pen for the idea of ideas.

Now obviously, neurobiology is a prominent area of science in the mod-ern age but making connections be-tween conventional biochemistry and people’s thoughts is still shrouded in mystery. Prozac was probably a good start in trying to physiologically define depression. It slows the reuptake of serotonin by the body, and it made you happier. So serotonin is what makes you happy right? No, because there are

drugs that do not affect mood but do af-fect serotonin, and drugs that do not af-fect serotonin but do affect mood. We generate dopamine when we sleep to re-sensitise our neurones, but why does this make us feel more awake? I'm not talking about physiology, I'm talking about the redness of red, and the sad-ness of sadness. Or am I?

The concept of eliminating the idea of the mind is mind-bending. I'm de-feating the argument as I write it, aren't

I? This arrangement of letters on a page are brought about by the idea of this article in my mind, isn't it? May-be not? I'll try an analogy to argue the point. What is a painting? A painting is a beautiful thing. It inspires, it en-lightents, it illuminates. Or rather, it is a collection of paint flecks arranged on a piece of canvas that seemingly gives rise to these complicated properties. But what if you could never get close

I tried to pin down a single thought, to dissect it with my scalpel, but it escaped me with all the grace of a butterfly.

enough to the Mona Lisa to realise it was a painting at all? All your life, you would see it as what it is intended to be seen as, a beautiful woman. And that's what consciousness is, an illusion. It is mentally painful to try and peer around the back of the mirror but I think it's where the mystery of the mind ends. When does a foetus gain a mind? Nev-er. Because 'minds' aren't real things, just like the beauty of the Mona Lisa.

"What is a painting? A painting is a beau-tiful thing. It inspires, it enlightents, it illu-minates. Or rather, it is a collection of paint flecks arranged on a piece of canvas that seemingly gives rise to these compli-cated properties."

Opinion, subjectivity, and adjec-

tive description dissolve in the sea of neurobiological mechanism. Happi-ness would no longer exist. It would be replaced with a concentration of dopa-mine in the frontal cortex in the brain that is raised above normal.

Suddenly, our blinders would be taken off, and the mystery of depres-sion would just be waiting to be un-locked by complex neurobiology, not discussion about our non-existent thoughts. Would it really be so surpris-ing if the mind, like every other known thing, bows to the laws of science, and nothing else? The rabbit hole is a scary place to venture down, Alice, but there are no answers back at your garden party left to be found.

"Would it really be so surprising if the mind, like every other known thing, bows to the laws of science, and nothing else? The rabbit hole is a scary place to ven-ture down, Alice, but there are no answers back at your gar-den party left to be found."

Okay. I'm done trying to persuade you. Shake your head and blink a few times, as I will. Go back to reality. The reality of the beauty of the redness of red. The reality of the thrill and rush of climax. But, with it, the reality of 12% of people seeing every house party as a little less exciting, every sexual experi-ence feeling that little bit more numb and seeing every colour tinted by that unrelenting grey. And the reality where neither you nor your GP could ever un-derstand what depression, or a thought, actually is .

11

Commentmedicalstudent May 2012

How many medical students sigh when their OSCE station is made trickier by having to palpate an obese patient? I imagine quite a few. How many actu-ally wish to punish their patient? I im-agine very few. Yet, more than fifty percent of surveyed doctors on the net-working site doctors.net.uk expressed support for the notion to essentially punish obese patients and smokers by withholding non-emergency treat-ment. This is a disturbing statistic.

It is true some procedures are less efficient if the patient smokes or is obese and consequently 25 primary care trusts restrict access to procedures including hip replacements and in vitro fertilization. The trusts prefer to allo-cate money to patients who are deemed to live more appropriate lifestyles. This seems rather arbitrary. Following this line of reasoning, we should also sure-ly restrict access to dental fillings for people who eat sugary foods.

Applying such a penalty does not make sense financially. It is estimat-ed smokers contribute eleven billion pounds into the national economy in the form of tax revenue but smoking related diseases are believed to cost the NHS five billion pounds. The justifi-cation for penalising specific groups in society based on this principle is lacking.

"Following this line of reasoning, we should also surely restrict access to dental fill-ings for people who eat sugary foods."

How can it possibly be that doctors are contemplating this action? In light of the duty of care owed by doctors and the universal principle of non-malef-icence, knowingly neglecting patient care is wide of the mark. Furthermore, the first principle in the NHS constitu-tion guarantees ‘a comprehensive ser-vice, available to all.’ It must surely be an indication of a deeper issue beneath the superficial question of whether

certain patients deserve treatment. Scratching beneath the surface of this vote might reveal that growing num-bers of doctors are realising and begin-ning to grapple with the unsustainable growth in demand for NHS services.

"How can it possibly be that doctors are contemplating this action? In light of the duty of care owed by doctors and the universal principle of non-maleficence, knowingly neglecting patient care is wide of the mark."

People are living longer and chronic disease is an increasing financial bur-den. The health budget is buckling un-der this excess weight and even starting to falter as evidenced by the rationing of services that has already begun. The government has attempted to address these concerns by proposing long-term changes to service commissioning in the hope that money will be saved as

Vitamin D rains down from the sunny sky and I sit indoors with my plans for the evening cancelled. Anything to postpone revising for the upcoming test, I do my chores and twiddle my thumbs. When I can take the procras-tination no longer, I leave the house. I have no idea where I’m going, or how safe the area is, but I need to be out-side breathing the fresh London air.

I reach a junction and decide to turn right. I spot a car boot open with Sainsbury’s shopping on display and neither shopper or car owner in sight nor a front door open. People must be very trusting around here, I think, or just pushing their luck. After aimless wandering and noticing weird and ugly things, such as two rather grim and inaccurate bull dogs guarding a front door and Victorian carvings above doors, I realise I’m walking in a mas-sive square shape and will end up back in my room before I know it, so I be-gin to look for signs for a diversion.

The sign I decide to follow is a small, indiscreet sign that I never knew existed. It proclaims a lake and wa-terside nearby. Following the sign, I come to a neatly tucked away slice of paradise. A big green field lined by an impenetrable black fence. Following

the fence round, I accidently stumble across a community centre, and the most gorgeous lake I have ever set eyes on. I watch swans, geese, ducks and a few other species beyond my limited bird knowledge dance across the lake.

"Anything to post-pone revising for the upcoming test, I do my chores and twiddle my thumbs. When I can take the procrastination no longer, I leave the house. I have no idea where I’m going, or how safe the area is, but I need to be outside breathing the fresh London air."

As I walk around I witness a wom-an on the bank with a baby strapped to her front doing Tai Chi. An elderly gentlemen and his middle-aged son are tear-eyed at a memorial bench. In ad-dition to this, our four legged friends are running everywhere. As dog after dog races past me, I thank the heavens that the gene inherited by nearly every Pakisatani bypassed me – that gene re-sponsible for embarrassingly running to the opposite side of the road to any four legged creature.

After a good walk, I decide to head back, ready to sit at my laptop procras-

tinating a little longer. After 15 min-utes I realise that I may not have ac-tually been walking in a square after all and that I don’t know where I am. Unfortunately for me I left my Oyster card and money back in my room in my hurry to be spontaneous. Shrug-ging my shoulders, I continue with my adventure knowing that sooner or later I will return to my room, and if I re-ally don’t know where I am, I’ll ask for directions.

"I watch swans, geese, ducks and a few other species be-yond my limited bird knowledge dance across the lake. As I walk around I wit-ness a woman on the bank with a baby strapped to her front doing Tai Chi. An el-derly gentlemen and his middle-aged son are tear-eyed at a memorial bench."

Thankfully, a little while later, I rec-ognise a street name which takes me back to the shops I pass on a daily basis – the shop with the creepy owners, the kebab shop whose menu I have yet to try, a cake shop that doesn’t seem very appetising and the charity shop where I bought 16 books for four pounds.

Trimming the fat from the NHSDavid FisherStaff Writer

The carefully planned art of spontaneity

services become more targeted and cost efficient. For a while it seemed people were in denial over the predicament and opposed the proposals. Only recently has the watered-down and battered bill managed to scrape through the House of Lords.

The number of doctors who ex-pressed support for withholding treatments from sectors of society is evidence that the wind is blow-ing in a new direction. It shows that not only is there an acceptance that there is a scarcity of resources within the NHS, but also a new willingness to search for solutions. However, targeting people who pursue a way of life contrary to societal convention and subjecting them to a second-class standard of care is an unacceptable manipula-tion to tackle financial shortages. It is laudable that these doctors are thinking of how to tackle the long-term future of the NHS, but they must be careful not to stomp on people’s rights in the process, even if it will save money .

Zara ZebGuest Writer

David FisherStaff Writer

Farewell...

So long and thanks for the fish.

When I get back to my room, my whole body is calmer and re-laxed, and my brain is ready to take on the complexities of vita-mins and minerals. A smile lingers on my face long after the walk, and I want to smirk at the poor souls who need to search Google Maps for everything, schedule every lit-tle thing and most boring of them all, put a date in their diary to do something spontaneous.

"Thankfully, a little while later, I recog-nise a street name which takes me back to the shops I pass on a daily basis – the shop with the creepy owners, the kebab shop whose menu I have yet to try, a cake shop that doesn’t seem very appetising, and the charity shop where I bought 16 books for four pounds."

Next time I’ll be sure to take my Oyster card. Maybe I’ll see where a bus takes me and walk my way back? Who knows? The possibili-ties for an adventure are endless .

Rhys DaviesComment Editor

This marks the end of the last Comment section with me as its editor, before I am dragged, kicking and screaming, back to jealous embrace of medicine, that di-vine mistress. Kicking and screaming.

My time as editor has been fun, en-tertaining, at times, exhausting. In the beginning, it was exciting, lying to the editor-in-chief about my prowess in CS5. The middle pages of The Medical Student were my realm, to rule as I saw fit. For some things, I could follow the holy edicts of Saint Sarah of Pape, the most wise of prophets. Other things, I had to make up on the fly.

It has certainly been an experi-ence, putting together the biggest stu-dent newspaper in London each month. Most of time, my position just sat in the back of mind, the source of a quiet sense of pride. Then, as the monthly deadline loomed, the panic would be-gin and I would realise that I had no articles to run over four entire pages. More than once, I considered filling a page with just a brace of massive quota-tion marks. After a hearty slap, the ed-itor-in-chief convinced me to try print-ing actual words.

At this point my monthly salvation would arrive. My writers would send me their musings, from serious med-ico-political topics to wonderment at London transportation. The Medical Student, especially Comment, could not survive without the contributions of London’s medical students. Work-ing with just a fraction of our potential writers has been one of the most re-warding parts of this job.

So I’m off to brave new worlds and final frontiers! Oh, and medicine. But I’ll still be around, writing the odd thing or two. I might even branch out. I was recently published in a blog on the BMJ website (http://blogs.bmj.com/bmj/2012/05/01/rhys-davies-the-patient-will-see-you-now/). That was totally not a plug, I swear.

Anyway, I hope you’ve en-joyed reading Comment this year as much as I have enjoyed editing it. Goodbyeee… .

12

CultureCulture Editor: Kiranjeet Gillculture@medical-student.co.uk

May 2012 medicalstudent

The Doctor Will See You Now...

It's always something different when the doctor puts down the pills and picks up the pen. With Max Pember-ton, you have to wonder if he ever puts down the pen. With regular columns in The Daily Telegraph and Readers’ Digest, and now his third book, The Doctor Will See You Now, there can't be much time left for his patients.

I very much enjoyed his previous books, Trust Me, I'm a (Junior) Doctor - detailing his life as a first year house officer - and Where Does It Hurt - re-counting a year practising medicine on the streets - and was looking for-ward to this instalment. This book de-scribes his year working on a Care of the Elderly ward, perfecting his skills in general medicine before training as a psychiatrist. Presumably his fourth book will be called Take Two Of These And Call Me In The Morning.

In order to skirt around confiden-tiality issues, Pemberton fictionalises his encounters with patients and staff. Furthermore, the whole book feels novelised as events dovetail nicely

together for pace and narrative. How-ever, that doesn't damage the essential truth of the story that Pemberton is try-ing to tell. Many of his patients serve as springboards or examples of a wider social issue he wishes to highlight. Mi-chael Foxton did a very similar thing in his darkly humorous Bedside Sto-ries. Pemberton utilised this in his previous books also; homeless people, the mentally ill and the elderly - some-times all in one patient - are all areas where the failings of the NHS and our wider society are seen more keenly.

"Instead, Kafka-esque and byzantine rules and regula-tions, personified by the anonymous hos-pital managers draw Pemberton's ire."

However, Pemberton is fiercely supportive of the NHS and, of course, rightly so. Universal healthcare, free at the point of access, is some-thing to be always proud of. Instead, Kafka-esque and byzantine rules and regulations, personified by the anonymous hospital managers draw

Pemberton's ire, as well as 'Big Phar-ma', private finance initiatives, and nursing homes that medically cosh their residents with anti-psychotics.

Pemberton writes in a rather simple style. This gives the book an air of un-put-down-ability. Obviously aimed at a lay audience, some medical students may get impatient with this book but the inverse is surely worse. Anything intentionally aimed at medical people runs the risk of being terminally dull. The characters - based on real people, or a composite of real people - are not wholly two-dimensional but could do with more fleshing out. However, this isn't a novel so it is arguable whether that is necessary. It must be said that care is taken to build the patients' sto-ries, to make sure they matter as much as the point they are being used to convey. An endeavour worth while.

I won't go as far to say that this should be compulsory reading for medical stu-dents because compulsory reading is universally read by no-one. However, it is an enjoyable read, especially if you like reading about medicine outside of the lecture theatre, and it certainly does make for a change of pace from all the textbooks and academic papers .

Rhys DaviesComment Editor

Vintage Film Review: One Flew Over the Cuckoo's Nest

Once you have seen One Flew Over the Cuckoo's Nest, you don’t forget it. My first viewing was as a child, and an accident. I had snuck into the living room with the aim of watch-ing movies beyond the watershed as my parents slept. I remember be-ing transfixed to the grainy images on-screen, listening to the crisp dia-logue, sitting on edge of my seat the whole time. The violence left me breathless. I wasn‘t sure whether to close my eyes and leave the room, or to continue watching this ghastly spectre. Needless to say it was a long time before I repeated the experience and even today, the film is just as gruelling on the senses. That is not to say that it is not a work of art - Jack Nitszche’s score alone deserves eve-ry accolade poured in its direction.

The film, written by Bo Goldman and directed by Milos Forman, is set within the confines of a psychi-atric institution in Salem, Oregon, where the inpatients are involved in rehabilitation programmes overseen by Nurse Ratchet. She is a collect-ed over-matron, under the watchful

eye of whom the institution runs. The mantra and ethos of the place is dis-cipline, rules imposed with iron fists - but these systems collide violently with the introduction of institution-hostile Randle - played by Jack Ni-cholson - and thus a revolution begins.

"The film reflects the emerging sentiment of the time, where people were begin-ning to question the role of institutionali-sation ... and analys-ing methodologies applied in many of the asylums. "

Driven by a kaleidoscopic moral righteousness, he begins to convince the other patients of their worthiness, trying to re-focus their attention on re-integrating with society at large, rather than being distracted and cowed by their own lack of confidence and fear of rules and regulations. This is how the dye is cast and it is known that things can never really return to the way they were. Much befitting its era, the film reflects the emerging sentiment of the time, where people were beginning to question the role of institutionalisation,

rehabilitation and analysing method-ologies applied in many of the asylums.

The cast and characters are a bi-zarre bunch and their odd narratives and awkward, distinguishing looks are well reflected in the casting, all actors portraying a necessary wayward shifti-ness. However, they remain stubbornly adorable and intriguing - the subplots drawing in the viewer in and forc-ing an emotional intimacy that makes the twists, the deaths and the heart-breaks all the more poignant. It is dif-ficult to know when Nurse Ratchet be-comes the enemy and what she stands for, but it is without a doubt a movie about underdogs fighting something greater, something oppressive and she makes a convenient poster-girl against which their frustrations are focussed.

It is difficult to write about this movie without wanting to discuss what it means. Beyond being a human, ten-der story about the lives and hurts of a motley bunch it could also be an an-ti-establishment tale or a warning to society about where medical institu-tions can go wrong. This is all for the viewer to discern, but it is undoubtedly a well crafted piece of art, deserving of every award, and the merits of which have rarely been repeated by either the literary world or Hollywood .

Durria RubatGuest Writer

13

Culturemedicalstudent May 2012

Brains: The Mind as Matter

‘Brains: The Mind as Matter’ is a major ex-hibition currently on at the Wellcome Collec-tion. Anyone who’s read my columns before will know that I’m a big fan of the museum, and having been to a fair few of its exhibitions I seem to have developed a mantra: expect the unexpected. I consider myself something of a neuroscience enthusiast, but as my knowledge is stuck firmly at the molecular level, I was re-ally interested to see how the exhibition would deliver its promise of focusing on the brain as a physical object - one that we can slice up and scrutinise, pickle and preserve – rather than on any notion of the brain as a control centre. And so, after watching a promotional video depicting something called a skull plough, having also played an incredibly exciting and reasonably informative axon-themed game and observed a warning about the disturbing nature of some of the exhibits, it was with a slight degree of trepidation that I paid my visit.

‘Brains’ was by far the busiest exhibiton I’ve been to at the Wellcome Collection - a testament to our enduring fascination with what is arguably one of the most complex and mysterious systems in the universe, and a sure sign that once again the Wellcome Collec-tion has come up trumps with its latest offer-ing. The exhibition is split into four parts – Measuring/Classifying, Mapping/Modelling, Cutting/Treating and Giving/Taking. Span-ning from a mummified brain from ancient

Egypt to a very modern piece of artwork in-corporating a QR code that links you to MRI scans of the artist’s brain, the exhibition is very much about a meeting of art and science.

On entering the exhibition, the Measuring/Classifying section shows how 18th and 19th century scientists and doctors became obsessed with the idea that the appearance of the brain and skull could uncover key personal traits – intelligence, or criminal tendencies, for exam-ple. On the relatively harmless end of the spec-trum, this incessant classification gave rise to the quack science of phrenology, but much more sinisterly also led to attempts to link brain size or appearance with the evolutionary progress of different populations, including by Sir Fran-cis Galton, the so-called father of eugenics.

In the Mapping/Modelling section I felt I was on familiar turf, and was slightly awe-struck to see in real life a selection of the beau-tifully intricate etchings of Santiago Ramón y Cajal. The Cutting/Treating section con-tained, as one might expect, the usual assort-ment of curiosities – trephined skulls, bullets lodged in brains and an array of barbaric-look-ing surgical instruments-cum-torture devices. The ‘skull saw with crank handle’ particularly sticks in my mind, looking, as it did, a bit like a high-tech pizza cutter. Another fascinating exhibit was the futuristic MD20-3D Medi-cal Imaging System which uses composite CT and MRI images to create holograms of the intracranial cavity, brain and vasculature.

Whilst the general public is likely to be equally fascinated and disturbed by the sight of pickled brains in jars, as a medical student

I had a slightly smug feeling of ‘been there, done that, got the formaldehyde on my tee-shirt’. So for me, where the exhibition really excelled was not in the physical specimens on show but in the Giving/Taking section, dedi-cated to those who donate their brains to medi-cine and science. I was really moved by a se-ries of photographs entitled ‘After I’m Gone’, and I now feel more privileged than ever to be able to say that I have held a human brain. The desire of the donors to make a difference in the world is both humbling and inspiring.

Another highlight of the exhibition was the artwork that was a common element in all four sections. In addition to anatomical draw-ings, there were a number of creative pieces. Two pieces, ‘Me, Myself and I’ and ‘Hearing Voices’, are particularly memorable, depict-ing the terrifying loneliness and inescapabil-ity of mental illness. A series of self-por-traits by artist William Utermohlen chart his descent into Alzheimer’s Disease, his once colourful and intricately detailed work be-coming increasingly simplistic and distort-ed. His final piece of work, a simple sketch, is barely recognisable as human – a stark and sad reminder of how Alzheimer’s dis-ease cruelly robs its victims of their faculties.

With so many amazing things to see, ‘Brains’ is a wonderfully curated and beautiful-ly presented exhibition, and truly cements the Wellcome Collection’s self-created accolade of being a destination for the incurably curious .Brains: The Mind as Matter is on at the Wellcome Collection until June 17th.

Online RevisionAshik Amlani (ICSM)

As exam season draws ever closer, we medical students leave no stone unturned when it comes revision. A common concern seems to be the lack of realistic practice questions, in no small part due to the universities' reticence regarding the release of mock questions. How is it, then, medical students can get access to this most holy of revision grails? Well, where there's a will, there's a way. There are a plethora of resources available to the enterprising medical student. Those of you in clinical years will be familiar with the revision EMQ books on the market such as PasTest or Get Ahead!, but perhaps not so aware of similar online offerings by companies such as OnExamination, PassMedicine, and the subject of this review, Exam Consult. The premise is simple - you pay a subscription, and they give you access to thousands of MCQs with answers and feedback. Exam Consult, created by Elsevier, is no different. They promise over 2000 questions (about half that of some other websites) written by an "expert" panel with short rationales from your favourite textbooks, performance analysis, and the ability to customise your own tests. I approached this review well versed in the competition, and I had high hopes for Exam Consult. They cater for all stages of medicine, whether you are doing basic sciences or if you are looking for finals questions. You can choose a length of subscription ranging from one week up to twelve months. A good, but hardly groundbreaking, feature of the website is that it allows you to pick and choose exactly what topics to have in your test that you create for yourself. Then, you have to pick whether you want to do the exam under timed conditions with answers at the end, or as a practice session with answers after each question. Finally, choose how many questions you want and you're off! Deciding to start alphabetically, I picked 30 cardio questions to warm up. Unfortunately, on first glance there seemed little to compliment. The general interface and usability of the website left a lot to be desired, especially when contrasted with the strong offerings from others such as OnExamination. Navigating from question to question and receiving feedback is not intuitive, and could do with polishing. The question content, however, is where Exam Consult shines. Having done questions from many other sources, I found Exam Consult appropriately challenging and varied. An external examiner for two UK medical schools was heavily involved in the creation of these questions, and it really shows. I personally found the questions extremely useful in preparation for my EMQs. The explanations were also taken from such books as Kumar and Clark, ensuring their quality and authenticity. There are, inevitably, some downsides. Whilst the quality of the content cannot be refuted, Exam Consult offers little in the way of extra features such as mobile access, the ability to pick questions of varying difficulty, or access to e-lectures. They do, however, give you free access to some bonus online content on Student Consult. Finally, the issue of cost. With a three month subscription for £30, Exam Consult compares favourably to OnExamination (£36 for 3 months), but not to PassMedicine (£10 for 4 months) and PasTest (£35 for 6 months), especially seeing as the question number is smaller. The ability to buy in small chunks such as one week or month is unique to Exam Consult and means you aren’t tied in, a key advantage in my view. So if you're looking for an online revision tool, you're spoilt for choice. If money is no object and the relative lack of extra features or finesse does not concern you, I would recommend Exam Consult due to the sheer quality of the questions. If, however, you are looking to get the best value for money, then I would also consider

Kiranjeet GillCulture Editor

My Soul (2005), a laser engraving by Katharine Dowson. Credit: Wellcome Library, London

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