Tuesday 14 February 2012

Junior Doctors / Gap year plans!

Been watching the Junior Doctors programme on TV at the moment, it’s been really interesting for getting inside the life of an F1 or F2. It’s quite heartening to see them not always getting it right, it helps me to imagine how I might cope if I was a Junior Doctor, and how to learn from mistakes! One thing that’s really become apparent after watching this series and the last is that the age of the doctor really makes a difference to his or her level of care. Of course, competence comes from experience, so F2s are more confident than the F1s but those who are older tend to have a much greater depth of maturity and this helps their care. There was a student on the last series who was 29 by the time he was an F2 and he was by far the best of all of the doctors! For me, it’s really reinforcing the idea of going on a gap year before I start medical school. I feel like it’s really important to have real life experience and be worldly before one becomes a doctor, and the programme has backed up that idea. It would give me the opportunity to visit different parts of the world, and begin to live more like an adult. I would really like to visit Asia again after visiting India, and my cousin has made me aware of a contact she made in Sri Lanka who offers places in his hotel for volunteers at a really low cost! It works out relatively cheap per week in comparison with other more expensive schemes and I would really love to take the opportunity to go and see more of the world before I become highly invested in medical school. I would also love to see more of Europe, especially Eastern Europe, and also take the opportunity to get some real work experience in a hospital or do some really worthwhile voluntary work in local hospitals, seeing as places are limited below the age of 18.

Monday 13 February 2012

In the news today: Organ Donation - the debate...

On the news today, new discussions have been surfacing on organ donation and how to bridge the large void in lack of organ donors to meet demand. There is the withstanding debate as to whether organ donation should become opt-out or remain opt-in – becoming opt out would mean that more people would become organ donors if they had no particular desire for their cadaver to remain intact, instead of the current system, which requires donors to have a particular desire for their organs to be used. According to the BBC with welsh government are planning to introduce an opt out scheme commencing by the summer of 2012 [http://www.bbc.co.uk/news/health-16988213]

Awareness is increasing however; the previous three years have seen an increase of 25% in organ donors. The figures still full short of the 50% target set by the BMA for 2013. Suggested ideas to increase donation include allowing higher risk donors to donate, reducing the refusal rate with encouragement and to ventilate patients to no advantage to their health, but to increase their chances of successful donation. Obviously a system such as the latter would be seriously controversial and if there were complications in the process causing the patients health to be, it could give rise to mass rejection of organ donation by other patients too. Another option to be considered is of a ‘softer’ opt out, which allows families to say no to donation on behalf of their deceased relative. Another possible approach is reciprocity – those who are donors will have a higher priority for organ donation over those who do not. To begin to prioritise health care like this would, too, be controversial – instead of judging a patient on their state of health and fitness, patients could be judged on their social decisions, and although arguably fair, would no doubt give rise to further controversy.

When compared to Spain, the UK has a much lower donation rate – they operate on an opt out system, although they do ask the permission of the relative before any action is undertaken. They also incorporate the use of higher risk patients and have more intensive care beds, which means that more organs are readily available for donation.

Overall, I believe the best practice to be awareness. The population should adopt a psyche where one is clear that they are for or against donation of their organs to avoid discrepancy; currently 43% of families reject donation of their relative’s organs, purely because they did not know their wishes. Awareness would decrease the requirement of an opt out system, because people will become increasingly more conscious of the problem and take steps to sign up for the service to help. 
Went to a careers conference yesterday to hear lectures from doctors, careers advisers and current medical students talk about their experiences! Was really interesting to chat to the medical students about medical school and what it’s all really about... they chatted about their interviews and how they coped with the pressure of getting good grades and staying well rounded. They also gave me an insight into what being a med student is really like. I found out about optional modules which are available to medical students to make them more ‘well rounded’, such as languages and sciences such as anthropology. This made me feel more comfortable about the idea of medical school and has made me really excited about the prospect of going! It seems to be so diverse and wrought with opportunity to study what you are really interested in.

Tuesday 7 February 2012

Work Experience: Cataracts Surgery in India, October 2011

The previous post on stem cells reminded me of my trip to India, back in October 2011 last year, where I went to see an Indian eye hospital in Chennai, Tamil Nadu. I was lucky enough to be invited into a cataracts operation...


The surgery involved the removal of the crystalline lens of the eye (which in a cataracts patient has become opaque) and the replacement with a synthetic or donated lens. The patient is placed under a local anaesthetic to reduce pain and irritation to the patient as a result of the pressure sensation; the eye is held open with a speculum; the surface of the eyes is kept moist using sterile saline eyedrops. The surgeon then breaks down the lens using an ultrasound wave which causes the opaque lens to disintegrate; the lens is then sucked out from the eye, and the lens has been removed. Finally, the surgeon inserts the new lens into the eye, and the operation is complete! Being in the operating theatre was exhilarating; I felt so privileged to be allowed into the environment and trusted by the doctors to observe. After the operation, the patient was allowed to get up and the cloths from her face were removed... she then proceeded to thank everyone in the room for returning her sight to her. The experience made me realise the true relationship between a doctor and a patient – one possesses the potential to change a person’s life and improve their standard of living significantly. 

Friday 3 February 2012

Stem Cells!

As previously mentioned, I have begun researching stem cells as part of my research project to be published my Medlink. At the end of January there was a media upsurge on reports about stem cells; this came as a result of stem cell trials in the US reported that two patients had showed positive improvements as a result of their treatment; they both had retinal stem cells injected into the back of the eyes, behind the retina. The trials were initially devised in order to test the safety of stem cells, although the results were more positive than they could have envisaged! Both patients showed no signs of ‘normal proliferation, teratoma formation, graft rejection, or other untoward pathological reactions or safety signals.’ The Advanced Cell Technology company told the BBC (http://www.bbc.co.uk/news/health-16700394). Although the trial was testing safety, the fact that the patients’ vision had improved was impossible to ignore! One of the patients was an elderly woman with ‘macular degeneration’ which is the leading cause of blindness in the world. This results in a loss of vision in the centre of the visual field, known as the ‘macula’, and can also effect contrast and colour vision, which is caused by damage to the retina; no known cure has been found to this condition, apart from high doses of antioxidants which are able to slow the degeneration process (http://en.wikipedia.org/wiki/Macular_degeneration). The other patient, who is in her fifties was suffering from Stargart’s disease (macular dystrophy), which is a hereditary form of macular denegeration, but is essentially the same (http://www.medicinenet.com/script/main/art.asp?articlekey=62582). The improvements in vision caused improvements to their lives – the New Scientist reported that her independence had been increased as a result of being able to use her watch and computer, things which we take for granted! (http://www.newscientist.com/article/dn21387-blindness-eased-by-historic-stem-cell-treatment.html)

Across the Atlantic, here in the UK, trials of a similar nature have been undergoing at Moorfield’s eye Hospital in Central London. Obviously it is important to consider that the results are not conclusive and currently it is unclear whether the results are indeed as positive as they seem, or whether they where a result of the immunosuppressive drugs used, or the placebo effect. The trials will now continue, and so time will tell as to what effect stem cells are likely to have on the future!

Stem cells excite and inspire me – looking to the future, it is likely that stem cells will play a larger and larger role in medical practice, and may become highly prominent by the time I qualify as a doctor!