As students of medicine, you will soon be educationally unique – with a body of knowledge that no one can ever take away from you.
When you receive your MBBS, the society and community in which you live is making a statement of trust in your abilities. With that trust you will be afforded extraordinary privileges and esteem. However, with the esteem and privilege comes the heavy responsibility of your patients’ well-being. You are all remarkably capable – and, remarkably fortunate to be so capable…
According to the Australian Institute of Health and Welfare, we gained over 25 years of extra life expectancy during the 20th century. These extra years have resulted largely from development of public health measures, vaccines and antibiotics that have reduced the impact of infectious diseases on a global basis. These interventions are the tangible result of medical research conducted by health care professionals and scientists worldwide. Over the last 100 years, there has been a slow but steady revolution in the way that medical research is conducted. What was once the province of hobby scientists, working alone in spare time and using their own funds, in lab space hidden away in hospitals and medical schools, has become a multi-million dollar business, conducted in large biomedical research institutes by professionally trained government and industry funded scientists and clinician scientists. Why has this change come about, and where is this leading?
The early drivers of medical research were the desire of the health care professions to ensure better health outcomes for their patients, and the curiosity of scientists about human physiology and pathophysiology, and these remain relevant today. However, as the technologies available for research have become more sophisticated, and the existing knowledge base more extensive, research has required more prior education, more sophisticated facilities, more collaboration, and more money. Further, the funding model for universities, the traditional trainers of researchers, has changed to one driven by quantity of throughput in addition to quality of output. In consequence, further drivers have emerged which have encouraged a more commercial and managed approach to research. These include desire of universities to maximise student numbers and research grants, government desire to see outcomes from research at affordable prices, and a growing “for profit” pharmaceutical industry hungry for the next blockbuster product, that might be expected to sell over $1billion per annum in the first years of launch. These drivers have increasingly led to focusing of research into institutes that can compete on a world playing field for resources and talent, and can afford the increasingly sophisticated infrastructure of the large scale “hypothesis free” approach to biology currently being practiced.
These drivers will likely continue to influence the conduct of medical research in the first decades of the 21st century, though some new ones have recently emerged. The supply of blockbuster drugs has largely dried up, at a time when many of the major successes of recent years…
Sally is a pregnant nineteen year old woman at eight weeks gestation. Sally is currently serving time in gaol and has arrived at the hospital gynaecology clinic with several members of Justice Health.
Sally is informed that the hospital can offer surgical termination of pregnancy and she is advised about the possible complications and risks of the procedure. Upon hearing these, Sally becomes tearful. The doctor advises Sally that she should not terminate the pregnancy if she has any uncertainties. Sally explains that she is concerned about the risks of the procedure, but still wants to go ahead with the termination.
As part of her initial assessment, the doctor performs an ultrasound. The consultant points out the fetal poles and heartbeat stating, “Here is the baby’s heart beating.” Upon hearing this, Sally begins crying and becomes withdrawn, not responding to any questions. The doctor concludes that Sally should be given more time to contemplate whether she wants to terminate this pregnancy and does not book her in for the procedure.
The above clinical example raises a number of ethical issues in regards to abortion. Can the woman make an informed choice without coercion when she is shown the ultrasound in this manner? Is the autonomy of the patient compromised when she is forced to listen or view information that is not necessary to her medical care? Is it in the patient’s best interest to show her the ultrasound without first asking her preference? In this article I will focus on the medical ethical values of autonomy, informed consent and beneficence in regards to the use of pre-procedure ultrasound for abortion…
During my elective term in early 2010 at the Royal Free Hospital, London, I was presented with a fantastic opportunity: to learn how to perform a laparoscopic gastric bypass procedure. The challenge was for myself, a medical student and complete novice in laparoscopic surgery, to use the hospital’s state-of-the-art screen-based simulation technology to become proficient in a specific operation within six weeks in this rapidly advancing area of surgery.
My training was to be undertaken using the Simbionix LAP Mentor (Simbionix, Cleveland, Ohio, USA): an advanced piece of technology made up of a computer with simulation software and accompanying hardware, consisting of ports and instruments. The difference between this and a video game is the presence of haptic feedback; when you hit something or pull it, you feel the corresponding tension, making it a highly realistic representation of surgery…
Empathy and the medical student – Practice makes perfect?
The observation of another person in a particular emotional state has been shown to activate a similar autonomic and somatic response in the observer without the activation of the entire pain matrix, not requiring conscious processing, but able to be controlled or inhibited nonetheless. [2] This effectively means that when we see someone in physical or emotional distress, we too experience at least some aspect of that suffering without it even needing to be in the forefront of our consciousness. As medical students we are constantly told to “practice” being empathetic to patients and family members. What we are really practicing is consciously processing this suffering we unknowingly share with these people in order to develop rapport with them (if not just to impress medical school examiners).
We are taught an almost automated response to this distress, including a myriad of body language and particular phrases, such as “I imagine this must be very difficult for you,” to indicate to a patient that we are aware of the pain they are in. Surveys amongst critical care nurses have shown that gender, position, level of education and years of nursing experience have no significant relationship with the ability of a person to show empathy. [1] Thus it could be said that empathy is less of a skill which can be practiced until perfect, and more of a mindset that makes us as human as the people we treat…
“‘Change’ is scientific, ‘progress’ is ethical; change is indubitable, whereas progress is a matter of controversy.” – Bertrand Russell
Forty years ago it was generally accepted that a baby born more than two months premature could not survive. Now neonates as young as 22 weeks can be kept alive with medical intervention. This essay will explore the medical, social and legal aspects of artificial resuscitation of extremely premature neonates and argue for a change to a palliative approach towards infants born at the threshold of viability.
Background
Extremely premature newborns face a number of medical problems, affecting almost all systems of the body. These problems include extreme skin immaturity and fluid balance instability, lung immaturity and breathing problems, malnutrition and gut damage, retinopathy of prematurity, early and late onset infections and brain damage which can lead to a spectrum of long-term neurological sequelae. [1,2]…
Figure 1. Baby hospitalised for suspected bacterial pneumonia.
“In Africa, you do not view death from the auditorium of life, as a spectator, but from the edge of the stage, waiting only for your cue. You feel perishable, temporary, transient. You feel mortal. Maybe that is why you seem to live more vividly in Africa. The drama of life there is amplified by its constant proximity to death.” – Peter Godwin. [1]
Figure 1. Baby hospitalised for suspected bacterial pneumonia.
Squeezing into our rusty mutatu (bus), we handed over the fare to the conductor, who returned to us less than expected change. In response to our indignant questioning, he defiantly stated, “You are mzungu (white person) and mzungu is money.” This was lesson one in a crash course we had inadvertently stumbled into: “Life in Kenya for the naïve tourist.” More unsettling than being scammed in day to day life, however, was the rampant corruption in the hospital and university setting.
We completed our placement at Kenyatta National Hospital, the largest referral centre in Kenya, with 1,800 beds, 50 wards and 24 operating theatres. I was based within the paediatric ward and paediatric emergency department…
As stated by Sparks and colleagues [1] in their comparison of Clinically Oriented Anatomy and Gray’s Anatomy for Students, studying anatomy can be a challenging endeavour. This is true even more so for the study of neuroanatomy, which many students find particularly overwhelming. In the neuroanatomy textbook arena stand two ‘gold standard’ textbooks: Neuroanatomy through Clinical Cases, by Hal Blumenfeld, and Clinical Neuroanatomy, by Richard Snell. Inspired by the aforementioned comparative anatomy textbook review in the previous issue of the journal, I ponder the question: Which neuroanatomy textbook is superior, the more established Snell or the newer Blumenfeld?
I begin my comparison with a consideration of their similarities…
In early 2010 the Commission on the Education of Health Professionals for the 21st Century (the Commission) convened to outline a strategy for advancing healthcare towards a system that provides “universal coverage of the high quality comprehensive services that are essential to advance opportunity for health equity within and between countries.” [1] The strategy focuses on the education of health professionals to empower their capacity as agents of social transformation. [1] This paper endeavours to encourage medical students to think critically and ethically about the consequences of different modes of health finance on the equity of the Australian healthcare system. In doing so, it contributes to this project of health professionalism in the 21st century.
Health finance may seem of little relevance to aspiring or practicing health professionals. However, it is an important determinant of how and to whom medical services are delivered and a critical aspect of Australia’s response to the increasing resource demands of the healthcare system. Rising costs are attributable to a variety of trends including innovative but expensive technology, an ageing population, and increasing prevalence of lifestyle associated disease. Policy makers continue to debate the most effective funding methods to achieve effective use of resources, quality services and equity within the healthcare system…
This photograph was taken during a four week elective placement at Ilula Lutheran Hospital, located in the southern highlands of rural Tanzania, East Africa. It emphasises the innocence and resilience of this country’s generous, kind people.
Ilula Lutheran Hospital is a 70-bed facility with a geographically broad service area. Patients often travel long distances to seek attention at the facility, and present most commonly with conditions such as malaria, complications of HIV, malnutrition, trauma, burns, respiratory and diarrhoeal illnesses, often in their advanced stages.
This photo was taken while visiting a village on an HIV outreach clinic. Nurses and doctors attend villages monthly to diagnose new patients, dispense anti-retroviral therapy and perform general check-ups. The rate of HIV infection in the Ilula area has not been accurately measured; however, the infection rate has been estimated at approximately 20% in the general community and 50% amongst hospital inpatients. The day this photo was taken, the nurses and doctors were helping villagers form a support group to facilitate communication between them and the hospital, to encourage new patients to seek help and to give existing patients a support network to aid with compliance. This little boy was shy as he hid behind the skirt of his HIV-positive mother. The support group was named Tumaini – hope.
This photo was the winner of the 2011 Medical Students’ Aid Project photo competition. MSAP is a not-for-profit organisation run by medical students from the University of New South Wales. MSAP’s goal is to send targeted aid to developing world hospitals visited by UNSW medical students on their elective terms. This is done through collecting donations of equipment from hospitals and doctors around the state, as well as fundraising to purchase additional equipment and arrange for delivery of these supplies. To ensure that the equipment sent is appropriate and useful, the hospitals are asked to compile a “wishlist” of required supplies. In addition, MSAP also educates medical students on issues associated with global health throughout the year. To find out more, and how you can help, visit www.msap.unsw.edu.au today!
