Author: Worsley Times

Heroes are self-sufficient, brave, ask for nothing in return and need no support. Yet we in the NHS did need support, we wanted and needed proper personal protective equipment (PPE) so we can be safe, not brave.  

Labelling us as heroes helps conceal failings and shifts focus to our heroism. Bringing the nation together to clap for carers every Thursday to show you support us might be uniting us as a country, but claps much like ‘thoughts and prayers’ don’t save lives. It has been said that heroes never die, but we NHS heroes are. 

What lightens our hearts are stories and videos of people cheering for the NHS heroes. Something the whole nation can get behind, uniting us in the war against COVID-19. It struck me as a strikingly similar to war-like propaganda. 

During World War I, propaganda was used to encourage, and shame, young men and women to serve their country. I am not criticising anyone serving in our armed forces. I want to highlight how this heady mix of glory, heroism, sense of nationalism and British exceptionalism is enough to get people to sign up to dangerous situations without stopping to consider if it is safe to do so. 

Posters such as this were commonplace, all part of the governments clever propaganda campaign to shame people to fight for them. When that wasn’t enough, The Order of the White Feather was started in August 1914 by Admiral Charles Fitzgerald to further shame people into signing up. 

There is a draw to enter a vocation which brings with it glory, particularly for students and young people, but it’s important not to dive head-first into a dangerous situation. During this time many healthcare students asked to sign up as healthcare assistants (HCAs) to help their ‘comrades in arms’ and become part of the workforce early. Final year medical students had their exams and registration pushed forward to get more ‘troops on the ground’. I too felt increased pressure and a sense of ‘duty’ to increase my work hours as a paramedic, but having colleagues get ill and die made me consider the reality of the situation with inadequate PPE and my own mortality.  

In emergency response, if you are not part of the solution, you are part of the problem particularly where going into a dangerous situation ill-equipped can be fatal. A fireman entering a burning building without any safety equipment only adds to the workload of their colleagues and likely the death toll. As such I ask you, if you chose to reduce your hours or stay at home to protect yourself because the risk of death was real, would you? An NHS hero not working, how shameful I hear some of you say.  

Getting more staff on the front lines was a driving factor during the pandemic, the NHS is understaffed as it is. However, our safety was at best a secondary consideration. With many of our NHS colleagues dying as a result I was struck by the similarity to findings in the Chilcot report. During the Iraq war a lack of PPE for defusing IEDs resulted in many soldiers on the front lines dying unnecessarily. Interesting how history repeats itself. 

No one deserves to die for the promise or belief of being immortalised as a hero, and to add insult to injury, our lives are apparently worth a £60,000 pay-out if we do die from COVID. Thank you Matt Hancock. I’m sure a pay-out equivalent to two-three years’ salary for some staff is great comfort to our families. If this money is available to be paid out, why wasn’t it used before to provide proper guidance, PPE and prepare for the pandemic? 

During this pandemic, the fundamental role of the NHS has not changed; providing healthcare to the UK populous that is free at the point of access. What has changed was how we manage our usual daily demands with huge volumes of new work coming through our doors, especially in intensive care, emergency and pre-hospital medicine. With the media storm, a spotlight was thrust upon us and our work was publicly elevated to sainthood. The NHS wasn’t created during this pandemic. It has been helping the public and saving lives for over seventy years. It’s amazing how quickly people have forgotten about the strategic dismantling of health and social care services, privatisation and refusal to increase pay in such a critical sector, especially when so many people clap and call us heroes. Will those who now clap loudest for the NHS chose to vote Conservative again?  

What will happen when this is over? Will the government give us the pay rises we have been asking for since 2010? Will the unnecessary A&E visits start again because people feel they can? Will frontline staff get support and proper justice when we are assaulted, spat at and verbally abused week in, week out?  

The sad fact is, heroes do die, and giving us ‘NHS heroes’ a memorial after the fact and a £60,000 pay-out does not absolve the people responsible for their failings and gross negligence of their duties to protect the health service and its staff, for all of us. 

As history seems to use glory to gloss over the true horror of war, we must not do the same with this pandemic. People must be held to account.  

I am not an NHS hero; I am an NHS worker.  

Matt Whitehouse

Attending party-based events during your time at university inevitably means some sort of contact with the drug culture that pervades much of extra-curricular life. The University of Leeds places consistently high in drug usage rankings, with 82% of 8000 students surveyed admitting to illegal drug use. Leeds with its multitude of students and universities has held a reputation as an eclectic party city, consistently in the top ten universities for nightlife. Despite this, there is little formal recognition of this drug culture by the university in any kind of campaign. I have heard many students anecdotally report ambulances turning up at “the majority of” house parties they attend. You do not have to converse with many students to hear of occasional catastrophic consequences including hospitalisation, psychiatric morbidities and rarely even death. Personally, I have been the only person with a shred of an idea of what to do when someone collapses from a drug overdose at a party. Being faced with the distraught friends of an individual who you know nothing about, monitoring his almost imperceptible breathing whilst communicating a potential overdose of a valium, ketamine and GHB to a 999 operator is, understatedly, stressful. Moreover, I am a person who is training to deal with these situations within a medical degree. Compounding the situation was the dismissive attitude of his friends, and I quote: “he does this every weekend, leave him on the pavement”. This individual I later found out was mechanically ventilated for two days and his next of kin had been contacted. At this point I understood that this really is a culture, an integral part of our society. A norm. The dismissal by his friends underpins this – collapsing from drug use is inherently ordinary to this subsection of students. So why are the university not stepping up sufficiently to acknowledge this problem? 

Undeniably, students and young people alike do and will always take illicit drugs. However, in recent years, the media has documented a rise in the abuse of different, more potent kinds of drugs – some purer than authorities have ever seen before. This has been seen with the likes of MDMA (ecstasy). Notably, last year a Sheffield student named Joanna Burns died as a result of a “super-potent” eighth of a gram of MDMA. This resulted in the incarceration of two other students for supplying her with the drug and consequently woeful aftershocks on the student community, family and friends. This phenomenon of students supplying and dying from drug use is not limited to Sheffield. In 2018, a University of Leeds student was sent to prison for supplying ketamine, cocaine and LSD from his Lupton room to “fund tuition fees”. Similarly, deaths have also occurred closer to home. In 2014, a Leeds Dental School student died after taking ketamine and heroin following her finals. Rather than seek medical attention as she struggled for breath, her friends abandoned her behind bins at the rear of their property, effectively snuffing out any chance of survival. Similar situations have been documented time and time again, most recently in the media storm surrounding the case of Louella Fletcher-Michie. She was left to die by her boyfriend at Bestival after ingesting the psychedelic 2CP. He feared imprisonment after supplying her with the drug and refused to gain medical attention despite her begging him for help. A culture of isolation remains when cases like these rear their heads, inevitably provocating the issue and causing further devastation. There is a tendency to look at these cases as a “one off”, rather than identify, research and address the wider reasons behind the current culture. At the centre of this is a fear of reprimand outstripping the need for medical attention – if we continue to engender this at university, the wake of death and trauma surrounding drugs will continue by rote.

In an attempt at harm reduction following the tragic death of Joanna Burns, Sheffield University Union (SUU) published a document on ‘taking drugs safely’, with a link to ‘The Loop’, an initiative involving testing of drugs and reports on local known batches of drugs with adverse effects. It is an initiative that is encouraging harm reduction amongst drug taking behaviours. Instead of being heralded as a progressive, health protective scheme, this advice was quickly revoked after extensive backlash from major newspapers. SUU was accused of ‘encouraging’ the use of illicit drugs and normalising drug culture. Although it is important for institutions to condone drug taking, the idea behind informing and educating students about safe drug taking should be strongly embraced. Waking up to the reality that prohibition will not halt the tide of student drug use and using effective education programmes would be a far more enlightened approach. This prohibitive, one line “zero tolerance” attitude without further information or guidance is at best, ignorant. At worst, it is irresponsible. Scouring Google and the Leeds University Union website found no comprehensive document or policy from the university around drug use apart from the increasingly repetitious “we have a no tolerance approach to drug use”. In the context of an increasingly litigious society where prestigious educational institutions cannot be seen to be tolerating drug use, this is somewhat comprehensible. Acceptable? I would argue not. I would challenge anyone in charge of drugs policy at the university to look into the face of an overdosing student as he struggles for every breath and tell me this approach is justifiable

Emma Reeves

If you’re currently a first year medic, your life has probably changed significantly in the past few months. You’re no longer taught by teachers in classrooms, there isn’t as much guidance as you had in sixth form, and, for most of you, you’re hundreds of miles away from your family at home. There’s also that thing… IMS. But don’t worry! In the next few paragraphs I will hopefully provide some guidance and reassurance about how to ‘do’ first year and what not to do. 

Firstly, the jump from A-level to Medicine is a big one and IMS lectures come thick and fast. Slides are packed full of information and you have only half a minute to read everything before the lecturer moves on to the next slide. Meanwhile, in the row in front you can see someone who has already made notes before the lecture and is typing literally everything the lecturer says into their notes. Don’t be that guy. The important information should be on the slides and you should only really add things which the lecturer emphasises and which help aid your understanding. Some people will have made notes before the lecture, some will add lots of unnecessary information, others will make handwritten notes – the most important thing to do is find out what works best for you. Don’t be put off by what other people are doing! If you’re not sure how much you need to know for a lecture/topic then seek clarification from lecturers and seminar teachers. 

Secondly, make sure IMS doesn’t put you off medicine. You’ve probably come to study medicine because you’re interested in human biology and want to treat patients. IMS is a relatively dry module with lots of biochemistry to begin with but I can assure you, things get a lot more interesting in second and third term with Body Systems – so just get through IMS and things will get a lot better. 

Furthermore, don’t be fooled into thinking 5 years is a long time – it really isn’t. Everyone always says that medical school will fly by and it may be hard to believe as a first year but it’s genuinely true. I’m currently in third year and I can remember being a first year like it was yesterday. Medical school goes by really quickly so make sure you try and make the most of it. There’s lots of really cool societies and so many different activities, sports and hobbies which you can try out. Find your comfort zone, run as far away as possible from it and expose yourself to new and challenging situations as that’s where you will grow the most. Get involved in as many societies and extracurricular activities as possible and most importantly enjoy your time as a student. After all, you’re only going to be a student once! Going to university to study medicine isn’t only about gaining the qualifications so you can become a doctor but it’s up to you to make the most out of it. Remember to take it easy – adapting to life as a medical student can be difficult at times but give yourself a break and make sure you leave time to relax. 

Finally and most importantly, sometimes in life things don’t always go to plan and situations can arise which complicate things, especially as a first year medical student living away from home. If this is the case for you at any point in medical school then please don’t hesitate to contact somebody – there’s a lot of great support available at the University of Leeds and there’s always someone available to listen and help.  

Bako Nouri

As winter days draw in, and it becomes darker by just a little each night, it seems natural to reach for something positive. Sadly, even a glance at the BBC news app on your phone or a minutes viewing of the 10 o’clock news fails to provide the comfort and hope we are looking for. Every day is full of some new Brexit-related story, election campaign blunder or horrendous (or possibly worse just plain stupid) statement for some world leader.

Cheery start.

Let me try to pull it back. While the topics selected by the news fail to cover the good that is going on in the world, I would like to highlight them, and as the year passes by provide some reason to look to the future with hope. Fair warning, given this is a medical paper the topics have a slight medical slant.

• Increased global life expectancy

Lets start with a big one. Life expectancy across all continents is improving. This is not to say that inequalities don’t still exist, but it is worth noting that the biggest increase in recent years has been in poorer countries in Africa and Asia. Overall between 1990-2016 life expectancy increased by more than 6 years for both men and women globally. 

• Decreased child mortality

Following on from the first, one cause for an increase in life expectancy is a decrease in death at a young age. Globally child mortality has fallen by more than half since 1990. In rapidly developing countries like China and India these rates have fallen even more significantly (83% and 69% respectively). Even more encouragingly those developing economies have lower child mortality rates now than advanced economies had when they had similar income levels, around a century ago.

• AI Healthcare

Modern media has created a fairly terrifying vision of an AI future (the fact that they have managed to churn out 6 Terminator films suggests evil AI is something people genuinely fear, or at least are intrigued by). The future may not be so dark however. AI can aid medics in numerous ways, such as disease detection, management of chronic conditions and mapping of both diseases and treatment plans. It could be used for transporting patients, or even as home aids to help the elderly, reminding them to take medication and alerting the outside world should something happen to a person living alone. While fundamentally I believe that people will always want and need healthcare from people rather than robots due to the emotional element of illness, AI could elevate the care we can provide for patients.

• Greater connectivity

There is great fear about data use, and rightly so, in the wake of Cambridge Analytica and Russian influence in the American Election. However, one area in which this increased use of data could have great benefit is healthcare. Data can be collected via patients’ smartphone or watch and sent to healthcare services to monitor patients’ health. This could be analysed to show patterns and indicate when an intervention might be necessary. As one doctor puts it “chronic patients have to live with the condition 24/7, so the care should reflect that,” and by sharing their health data we can pre-emptively diagnose and begin treatment for patients before it affects them as severely.   

• Improvements in Malaria Prevention

While malaria is still one of the biggest killers worldwide, though especially in Sub-Saharan Africa, improvements in prevention have been made. Now across Sub-Saharan Africa, at least 80% of homes have one anti-malaria net. These are one of the most effective ways of preventing new infection, and so increases in use has lead to a global decline in incidence of malaria.

• Improvements in HIV Care

Within the last 20 years deaths related to HIV have fallen by 43%, in large part due to ART. This has saved a total of 13.6 million lives, and means life expectancy with the disease is now approaching that for individuals without HIV. Not only is care for HIV improving but prevention of new infections is also falling, down by 37% over the same time period. This once terminal disease is now a manageable condition.

• Smoking is down

In western countries the proportion of people smoking is falling rapidly. Between 2011-2018 the number of smokers in the UK fell by 2 million, meaning there are now around 6 million smokers in the UK. This number is dropping year on year, and now well over half of people who smoke say they aim to quit.

This must be caveated however by noting that in the developing world reducing smoking rates has proved harder, and also that there is increasing health concern about the use of e-cigarettes and vape pens, but they haven’t been in use long enough to provide useful data.

• Cancer Progress

Every year since 1992 there has been a decrease in incidence and mortality rates as a result of cancer. 5-Year survival is increasing, so that 2 out of every 3 people with cancer will live for 5 years after the diagnosis. These are amazing statistics and while there is much more work to be done, it is clear great progress is being made and will continue to be made.

If you enjoyed this and want to read more on either the future of healthcare or progress that is being made on several global issues, you can find links to several interesting articles below:

https://www.vox.com/2014/11/24/7272929/global-poverty-health-crime-literacy-good-news

https://www.telegraph.co.uk/wellbeing/future-health/healthcare-predictions/

https://www.bbc.com/future/article/20190111-seven-reasons-why-the-world-is-improving?ocid=fbfut

Kit Stanford

There are so many factors which contribute to stress in University; whether it be meeting a deadline or not being able to find the right outfit for a night out. The key to managing stress is to firstly identify what is causing it and then to practice a form of relief to help resolve the problem. It is definitely easier said than done; but this article aims to provide you with some ideas of stress-relievers that may work for you if you haven’t tried them out before; or inspire you to find something new for yourself if you need to.  

1. Physical activity 

This is a brilliant mechanism which not only benefits your mental health, but also your physical. The built-up tension you may experience when you’re stressed can be diffused during physical activity, enabling you to deal with your problems more calmly. Whether it’s 10 star-jumps or a trip to the gym, taking a moment to channel the negative energy elsewhere may help control the levels of stress you are experiencing.  

2. Talk it out 

Talking about an issue can help you to come to terms with it through seeing it from someone else’s perspective and their take on it. In university, friends are great to talk to when there is something stressing you out; however, if you have a problem which you don’t think they would be able to help much with, for example a deadline, then it might be a good idea to talk to your personal tutor or any other senior member of staff. Also, if you are living away for university, then contacting people back at home for advice and comfort may be a great form of help. Sometimes just hearing the voice of someone close to you can be a means of stress-relief.  

3. Hobbies 

Although exercising may be considered a hobby to some, there are a large spectrum of interesting hobbies beyond that which may be considered effective ways to let off steam when you are struggling to cope with stress. Art-therapy and performing arts are good examples where you can express how you’re feeling on paper with different colours and materials and through voicing how you feel through performance. Sporting activities, like boxing, might be interesting to try out too because they release endorphins which are great for stress-relief.  Boxing helps you switch off from the outside world and be present in the moment; and this might be an effective way to help you get back on track when problems seem too big to overcome.  

4. Help other people 

Helping people through little acts of kindness can be great ways to lift your mood and consequently relieve stress. Feeding the homeless and participating in other forms of volunteering can help you appreciate things more and ultimately the problems that you have in your life may not seem that big and may become more manageable. In university, aiding someone with work they are struggling with may have a positive result; for example, they may be able to help you with something you’re struggling with or refer you to someone else who could.  

5. Preparation 

Essentially, if it is work which is giving you stress, it may be a good idea to get a planner and start breaking down your tasks across a particular time-frame in order for you to meet your deadlines and get everything you need to do done.  Sometimes unexpected events can arise, which may compromise your routine and put you behind. Therefore, in order to minimise stress and help you complete the work, it would be wise to save slots in your planner where no work is planned, so that you have catch-up slots to fall back on. Moreover, try to get your assignments done as soon as they have been set so that you don’t have to be panicking at the last minute. Even if you don’t start it, at least note some ideas down. Help yourself in whatever way you can.  

6. Sleep and routine 

Sleep and routine go hand-in-hand. Making sure that you are looking after yourself can decrease the amount of stress you’re experiencing in many ways.  When you have had enough sleep, your mind can function more effectively and therefore you would be able to think more clearly. When you have a lot on your plate or a lot to think about, it would definitely help if your brain was functioning well. Being tired and having a lot on your mind is not a nice combination. By creating a routine, you decrease the likelihood of having a poor sleeping pattern. In university it is common to sleep late. However, if you can, ensure that throughout the day you find time around your work to have a nap if you don’t get a solid 6-8 hours.  Particularly during exam season, create discipline and try to 1) limit the number of times you go out 2) create a curfew for yourself so that you get enough sleep 3) encourage your peers and people you live with to do the same so that you are more likely to succeed. 

7. Treat yourself 

A nice way to relieve stress is treating yourself, for example, to a new item or meal. Obviously if the source of your stress is to do with finances, then it probably wouldn’t be a good idea to splash the cash. However, treating yourself within your budget might be a nice way of celebrating small achievements that you did not acknowledge or give yourself enough credit for. This form of self-love can empower you, and make you feel good when you are stressed out.  

There are so many things which can cause stress as a student. Most people experience it, but the difference lies in the relieving mechanisms. It is really important to self-reflect and identify what helps you, in order to prevent you falling into unhealthy habits such as smoking and drinking for relief. A quick online or YouTube search can provide a much bigger insight of ways to deal with stress, so it may be beneficial to give yourself time to find something suited to you. Even if something doesn’t work, it is ok, because something else will.  

Halima Naeem  

Modern medicine often portrays the discourse between physician and patient as a one-sided transaction – the doctor holds an egocentrist position within the relationship, working through the taught models of assessment and prognosis to try and identify the root cause of the patient’s condition. But what would happen if we disregarded all of the acronyms, guidance and consultation frameworks, asking, ‘What do you think I should know about your situation?’ – a simple question proposed by Rita Charon, a Professor of medicine with a PhD in literary studies.  

In Charon’s 2002 paper ‘Narrative Medicine: A model for Empathy, Reflection, Profession, and Trust’, the medic-come-literary scholar examines the use of semantics within a clinical context in order to try and gain a deeper understanding of the effects of language and its consequences in a patient interaction. The ideas explored in this paper paved the way to a novel area within the field of the humanities, one which revolves around medicine and healthcare. Columbia University’s recently inaugurated Master of Science degree in Narrative Medicine is a course on the front lines of innovation when it comes to appreciating alternate approaches in the continuum of patient care. Charon writes: 

‘With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care.’ 

The programme encourages clinicians to look towards the often-neglected humanities in an attempt to bridge the gap between art and physiology. Literature is one such facet in which a narrative can be observed and is often described as the study of the human condition – a sentiment echoed by Charon in a 2018 interview. She moves on to discuss the inclusivity and sense of community that seems to be lacking in modern parochial healthcare systems of the West. Over her career within narrative medicine, Charon proposes a simple idea: replace the wooden, stereotypical approach with a new fluid model; one that helps to provide precision care that caters to the individual, avoiding a one-size-fits-all approach. 

There is of course an issue with this agenda. The problem lies more specifically with the disparity between America’s ‘privately funded patchwork’ of fragmented health systems and the socialized medicine of the NHS. Consultation times in the current climate of the healthcare service are simply too short to spin the chair onto the patient and ask them to tell you everything in just seven minutes. Publications by the NHS and the British Medical Association offer advice to help patients get the most out of their appointments but the suggestions are mainly focused on ensuring an efficient consultation rather than forming a holistic view of the patient’s concerns. For our friends across the Atlantic, where the majority of healthcare is provided via the private sector, this would be more feasible. Clinicians in America have the time to probe even deeper into the patient’s understanding of their self – albeit in a system with considerably less strain than ours – perhaps a nod to the fact that such programmes are of less interest here in the UK.  

However, some of Charon’s suggestions, at a more basic level, could be attained and implemented by many clinics across Britain. What Charon is ultimately proposing here is a greater sense of patient autonomy; something that allows for a greater degree of transparency between the clinician and their patient. Although practical guidelines are not very amenable to change, the individual manner of the clinician certainly is. Again, this is a sentiment shared by Dr Charon in just a few of her many TEDx talks that can be found on YouTube. Through her anecdotes, exploring her personal successes by way of narrative storytelling in her own clinic, she outlines her method very candidly – recounting how we are often told in school, university and beyond, that you should read as if every word counts. It is here an important parallel with literature can be drawn– if we can read where every word counts then surely, we can listen as though every word counts.  

Illness therefore exposes a patient and their vulnerabilities. Through narrative medicine we are provided with a novel framework to illuminate how concrete facts and symptoms of health can be imbued with a better sense of the patient’s self and individualism  – a doctor helps the patient to understand that in the limits of life we have meaning and likewise patient’s teach the clinician about the need for partnerships, helping us understand what it means to be stood in solidarity against our own mortality. Charon concludes that ‘by bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care’ – something we can all agree that the world needs now more than ever. 

Alexander Thornton

Rita Charon’s original paper can be found here: 

https://jamanetwork.com/journals/jama/fullarticle/194300

Information for the MSc in Narrative Medicine can be found here: 

https://sps.columbia.edu/academics/masters/narrative-medicine/full-time-master-science

Thanks to Abi Curran for helping with the revision of the article. 

Hi. I’m Niri, a buzzing second year medic. I’m excited to take you through a snapshot of my medic trip to Sri Lanka exactly two months after the Easter bombings. I know what you are all thinking, why did you go?

Why Sri Lanka?

This was a trip I had been wanting to do for many reasons. My late aunt had founded a clinical practice to provide free care for local citizens, but sadly before expanding it into a larger hospital she passed away from Dengue Fever. I was left wanting to see the amazing work she had done. I was also keen to explore the health issues affecting people from my mother’s homeland in the aftermath of the civil war between the Tamils and the Sinhalese. A final reason for this trip was to spend time with my mother. I care for her as she has several chronic illnesses and is in deteriorating health but we have always wanted to visit her old school. I wanted to take my mother and ensure that she could tick this off her bucket list, absorb plenty of Vitamin D and be exposed to the warmer climate of her youth, which might improve her health.

My trip to Sri Lanka was entirely possible due to being awarded a travel grant by the university, so thank you Leeds! At this point you really just want to hear about what I did, right?

What I was doing in Sri Lanka

I volunteered in a rural hospital named Tellippalai Base Hospital for two weeks and a teaching hospital for a further week meaning I had a varied experience of clinical practice in Sri Lanka.  I am going to focus on moments of my time at the rural hospital.

Upon arriving at the hospital, I was told to meet the Superintendent, who I was informed was Sinhalese. I was scared as I only knew a couple of phrases in Sinhalese. However, I somehow made him understand that I was a medical student who was going to be supervised by the visiting physician (VP); the consultant in charge of the hospital in terms of general adult medicine. To my dismay, the VP was not present this day as he had unfortunately ill and thus I was handed the files and told to see and assess the patients. I did not know what to do and panicked inside…

A few minutes later, I plucked up some courage and went to speak to one patient in Tamil, who had COPD and performed a chest auscultation to listen for telltale signs of COPD. I was then taught by a medical officer, who is similar in ranking to a senior house officer in the UK, how to ask for patient consent in a way that patients in Sri Lanka could understand. As I was speaking to one patient, all the patients wanted to talk to me and within a couple of hours I had gathered the histories of every patient on the female and male general medical wards. I then went to A&E and was able to able to practice performing chest and heart auscultations. I saw a vast amount and learnt how each condition was managed from TB, typhoid, dengue, bilateral polio, and various mental health conditions, such as schizophrenia. I was shocked to see the variety of ways patients had attempted to commit suicide; by scorpion sting, snake bite (including the infamous Russell’s Viper), colonies of wasps or stray dogs.

Seeing this I wanted to better understand how these conditions affected patients, so I asked to interview a patient with schizophrenia. A medical officer kindly took me to the psychiatric ward where I was handed a basic assessment form and told that I could talk to the patients. The patient I focused on believed that spirits had possessed her and that they were talking to her. She was also having visionary hallucinations. Seeing how culture affects a patient’s presentation was interesting as in Sri Lankan, belief in ghosts is common and if a person sees spirits they are believed to be possessed by one and so cursed. This means it is difficult to get a sense of a patients mental wellbeing as they believe they are cursed instead of unwell, which affects how they can be assessed and treated.

What did I gain?

It was a life changing experience – I went in with western ideologies, being fixated on the GMC guidelines but in the end I had realised that I had to adapt to the views and practices of the Sri Lankan healthcare system so that I could do the greatest good for the local citizens whilst not losing sight of my moral or ethical values.

Niralini Thayaparan

Scary or smart?

Plague doctors are, by anyone’s standard, terrifying. Armed with a nightmarish uniform and little to no medical training, they are the last thing you would want to see on your deathbed. But have they been treated unfairly? 

In our minds, they seem like terrifying individuals who would end up not only killing, but also scaring the living daylight out of everyone they treated. However, considering the limited knowledge and flawed science available, they are arguably pioneers of modern medicine and provided a basis for the healthcare we have today. 

Let’s start with the costume. Even though the plague began in Europe in the 1300s, the infamous outfit was not made official until 1619. Invented by Charles de l’Orme, the chief physician of Louis XII, the outfit consisted of waxed clothing, gloves, spectacles and the horrifying bird-mask. While this probably was quite a fashion statement at the time, it served another purpose- protection from infection.  

At the time, miasma theory dominated medical science and stated that disease was caused by a noxious form of ‘bad air’. In order to protect the doctor, bird-like beaks were filled with herbs and spices such as camphor, mint and cloves to cleanse the air and ward off infection. While the contents of your kitchen cabinet probably won’t ward off deadly diseases, this was the Middle Age equivalent of modern respirators, used to protect against air-borne diseases, and did have some logic behind it. Unfortunately for the plague doctors, oxygen tanks didn’t exist and holes were cut into the beak to allow them to breath, meaning many doctors ended up as patients themselves.  

Clothing was also waxed with suet to protect against these miasmas, inadvertently protecting them against any and all bodily fluids. Glass spectacles built into the mask completed the ensemble, and, although these were intended to protect against evil, they did a pretty good job of stopping any splashes from contaminating the doctors. Despite giving death metal bands a good run for their money, the outfit is reminiscent of modern protective equipment used in hospitals everywhere. All the basics: eyewear, respirators, full-body protection and splash-proofing, are covered in a similar way to now, just using limited resources and a dash of religious dogma.  

The perfect accessory? A long wooden stick, as essential as a sturdy handbag in the plague doctor’s wardrobe. As single-use silicone gloves were not invented, this seemingly primitive tool could be used to examine and communicate with plague victims, while still protecting their doctors from illness. Reports even suggest that plague doctors could take pulses using these sticks to assess a patient’s condition. Pretty impressive, considering how often we struggle to feel our own. Not only was it the perfect Medieval diagnostic tool, it was also pretty handy in avoiding the more aggressive patients, proving constant protection in more than one form. 

Now onto the treatments. This is where it gets a bit dicey as most of these would have worsened the illness and killed their patients even quicker. The plague was caused by Yersinia pestis, a bacteria carried by rats, and nowadays would be quite easily treated with a course of antibiotics. Unfortunately, penicillin was hundreds of years away, so plague doctors had to get a bit inventive. 

Therapies ranged from the usual blood-letting and pus drainage, to more outlandish treatments involving smearing human excrement on open wounds and sores. These got more extreme as the disease progressed, with some patients being covered in mercury and baked in an oven. While nowadays this would be considered barbaric and cruel, at the time there was a method to this madness. Humorism reigned supreme amongst medicine, and it was accepted by physicians that the body contained four humours: blood, yellow bile, phlegm and ‘black’ bile (probably partially digested blood caused by internal bleeding). Any imbalance in these humours was thought to cause disease, so practices like blood-letting were seen as the first line of treatment for most ailments. Perhaps a little outdated now, but at the time this was top quality healthcare. Even nowadays we recognise that draining pus is a good way to alleviate and prevent infections, but in a more sterile way. Compared to other prevailing theories, including zealous self-flagellation to avoid ‘God’s punishment’, this seems rather tame. 

Moving on from the wackier aspects of the job, plague doctors also contributed to the more tedious aspects of medicine. They kept detailed track of the number of casualties, even performing autopsies to certify the cause of death and learn more about the disease. These resembled medical records at a time when healthcare was a competitive and fragmented business. Around 150 million people (a third of the world’s population) died from the plague, but those seen by plague doctors were explained and accounted for, something quite difficult to do in the midst of a deadly pandemic.  

Plague doctors also abided by strict contracts, similar to the guidelines followed by modern day doctors. Employed by local authorities, plague doctors were required to treat everybody, regardless of wealth or status. Sound familiar? Bound by strict guidelines, clauses included how doctors were expected to behave around the public. This included that a custodian had to be present, similar to the idea of chaperones, whose job it is to protect patients’ rights and hold doctors to account. 

Infection control was also a huge part of their lives. Plague doctors agreed to only treat plague patients to prevent the spread of disease to patients with different illnesses. This was the Medieval equivalent of ward isolation and would have contributed to reducing the rate of infection. Not only this, doctors even agreed to live in complete isolation and quarantined themselves for lengthy periods of time after visiting patients. Considering most Medieval hospitals didn’t even have access to any medical care, this was quite a sophisticated practice. 

The most amazing part? Plague doctors weren’t even real doctors. Physicians at the time wouldn’t go near the plague, so it was up to those with little to no medical qualifications at all to pick up the slack! 

Were plague doctors kooky? Yes, undeniably so. But were they also ridiculously brave and way ahead of their time? Also yes. So next time you dress up for Halloween, remember that not only did they quite intelligently stand up to one of Europe’s most deadly diseases, they did it in style.  

Ashleigh Blood

10 Tips for a Successful Anatomy Exam

From all of the modules and topics that we study in the first two years of medical school, anatomy is one of the most difficult and challenging. The enormous workload and the limited time frame to learn the content in are two of the main challenges that medical students face. Are you worried about the upcoming anatomy exams? Not sure how to learn anatomy? Scared that it will be overwhelming? If the answer to these questions is ‘yes’, this article will give you 10 tips on how to learn anatomy, and more importantly, how to pass the anatomy exams 

1. Find the right anatomy book for you: There are thousands of anatomy books in the library and most of them are quite different from each other – they may be structured differently or may explain the concepts in different ways. It is therefore important to choose an appropriate book for you and stick to it. Try not to use too many anatomy books as this may confuse you. I would recommend using Gray’s for students as it is simple to understand and there are lots of pictures to help you to get your head around complex structures and concepts. The website Teach Me Anatomy is also a useful tool as it’s quite schematic and summarises the main points of each anatomical region.  
2. Use the self-directed learning worksheets for guidance: Anatomy is an enormous topic and it takes time to learn everything, but don’t panic! We don’t have to study everything in detail. When studying or making notes, use the worksheet provided by the university as they say what you need to focus on for your exams and can help guide your learning. If you have time and you’re interested then feel free to learn more and deepen your knowledge! 
3. Efficient notes: Not everyone likes to write notes when studying, but if you’re one of those that find it necessary try not to write too much. Write only the main concepts, summarising the points. You’re likely going to use your notes for revision before the exams so they need to be quite short. Why not try different ways of writing your notes? Also, if you’re looking to save time why not try using the Gray’s anatomy flashcards? They’re really useful and will likely help you to pass the exams! 
4. Make diagrams and drawings: These are tools that can help you in remembering complex concepts and identifying the structures in exams. Using them depends on your way of studying but I really recommend them. If you don’t want to draw, find some drawings or pictures on the Internet and add them to your notes. It’s important to visualise what you are studying as this can help to improve your understanding. 
5. Take out as much as possible from the session in the dissection room: It’s really important to attend each session in the dissection room as it is the only chance to look at the prosections in real-life. Try to complete the worksheet during the session and take this opportunity to ask the facilitators lots of questions. Look carefully at each prosection and try to test yourself on structures whilst there – this may help you to remember better. 
6. Study with the aid of an anatomy atlas: Although anatomy books contain lots of pictures, it might be beneficial to study with an anatomy atlas which will have pictures of the prosections. During the exams your knowledge will be tested using prosections, therefore it’s important to know where each structure is. Learning the theory is not enough if you can’t apply it. If you’re looking for a recommendation, I would recommend using McMinn’s clinical atlas of human anatomy.  
7. Learn week by week:  Leaving all the anatomy content to the last month before exams is quite dangerous. It takes time to familiarise yourself with the material and learn everything perfectly. My advice is to study the material before you go to the dissection room so that you find it easier to look at and remember the prosections. 
8. Ask when you need help: Medicine is quite a challenging course and at times it may be difficult or overwhelming to learn new content quickly. In this case, don’t panic! Ask for help: facilitators, professors and even your colleagues will be available and supportive. 
9. Test yourself with the material learnt: The only way to understand if you’ve really learnt something is to test yourself. The university provides a lot of formative questions that will help you not only to consolidate your learning but also to see if you know the material studied. It is also beneficial to study and practice some questions with a colleague. Two minds are always better than one! 
10. Strategic revision: You should aim to start revision at least one or two months before the exams. Try to create a revision plan so that you don’t feel overwhelmed the week before the exams. Remember, it might be difficult to cover all the material you need to in one month, so it’s important to be strategic and revise mainly the areas that you’re unsure about. It might be an idea to go to the dissection room with your colleagues so that you can test each other. 

I hope these tips are helpful to you when it comes to learning and revising anatomy. Obviously, everyone is different in their way of learning and revising, so it’s important to use the method that you find suitable for you. If you have any tips that you want to share with other students, please feel free to comment on this article! 

Sara Zonzer

What else can be done with a medical degree?

In the first few weeks of term at Leeds, many of us were told about the ‘end goal’ and our eventual progression into the NHS as fully qualified junior doctors. I imagined myself fresh out of medical school performing emergency heart surgery and confident that university had taught me all I needed to know despite having no independent surgical experience – an unlikely first day on the job for a 24-year-old junior doctor. That eagerness has since passed but the passion for medicine is still going strong, even after reading both of Adam Kay’s books. But the one thing that has been asked since coming to university is – what else can be done with a medical degree? And the answer is not as easy to find as one might think. There is sparse information available about alternative careers even on iDecide. The typical route of graduating and working till consultancy does still remain appealing but seems to lack something especially to those who studied a mix of the sciences and arts at A-Level. Although it is fair to assume the 99% of students want to practice, it still begs the question – if medicine as a whole is reliant on the multidisciplinary, why is the concept not fostered for the 1%? 

One lecturer’s analogy of a production line is perhaps the most fitting of the educational system we find ourselves in. They provided just one departure from the system however through academic foundation programmes (AFPs) – but this remains mostly in-line with clinical work. There are in-fact many fields related to medicine that often go un-talked about. Not just that, many of the essay competitions available to medical students are likewise open to students of law and politics leading us to think there is a more prevalent connection to the humanities, social sciences and arts than widely thought. The IDEALS strand of the Leeds curriculum does its best to address this common shortcoming and in doing so represents how humanities in general along with many other sub-disciplines, as argued by Grant, 2002 and seen in figure 1, can complement the medical field as well as how and why medical humanities should become part of the core medical curriculum. 

An integration of the arts and humanities into medical education can encourage development of the essential qualities of a doctor set out by the GMC including ‘professionalism, self-awareness, communication skills, and reflective practice’ (Wald et al.,2019). Here an important distinction has to be made: a lot of scientists are very narrowly focused on their particular field and, while this is both symptomatic of a PhD and a strength of detailed research, it does mean that a lot of their work lacks a wider understanding of different perspectives. Medics however are exempt from this. Medics while still scientists, require taking the stance of a much broader perspective; and an ability to contemplate any possible implications of their work and research is mandatory. It is here a greater understanding of humanities plays a pivotal role. Supplementing medicine with a study of literature for example necessitates a critical ability to change and shift focus and perspective. Whether you are reading a fiction text that asks you to believe in a world that differs from ours, or adapting your perspective to understand the words of a first-person narrative voice, or even in creative writing, trying to elaborate on things that you yourself have not yet experienced – all of this encourages and supports the development of a critical mind that can perceive and understand multiple possibilities, perspectives and opinions. It perfectly complements the scientific skills needed to research breakthroughs in medicine, technology and infrastructure – because an imaginative approach is far less restricted and restrictive. 

As stated earlier, the IDEALS strand plays a large role in encouraging future doctors to galvanise patient care through a more holistic approach, but this approach should not be limited to the medical profession. Career sectors ranging from the more closely related ethics and law to the further afield medical humanities can be supplemented by having a qualified medical professional in their employ and as mentioned, the medical profession can likewise benefit from this wider appreciation. Talking to those who have been involved in both the sciences and arts, it is clear they have benefitted from the multidisciplinary aspects of their studies. As well as this, an increasing number of graduates with backgrounds in economics, history and law are deciding to pursue graduate medicine courses so why is it ill-advised for medical graduates to do the reverse? 

Medicine is seen as a well-rounded career and albeit true, there are ways of supplementing it further. Taking an intercalation in the humanities, politics, economics or law should be encouraged and looking at ways your medical expertise can be used in ways outside of its original scope could provide alternative career prospects. Websites such as Medic Footprints are a testament to this and can provide examples of doctors who have used their skills taught at university for other careers including serving as an MP or consulting for medical technology companies. 

Studying humanities within medicine can ‘overcome the separation of clinical care from the human sciences’ and nurture careers other than that of a doctor by ‘foster[ing] interdisciplinary teaching’ (Gordon, 2005; Wald et. Al, 2019). While medicine is a vocational subject, the skills learnt are widely applicable and transferrable, and anyone brave enough to admit to wanting to jump from campus to (outside of) the clinic should be encouraged, and  we should be advising all medical students to continue their passions – as you never know where it could take you. 

Alexander Thornton