Would you tell someone they had basal cell carcinoma?

If you walked past someone in the street and noticed they had a suspicious lesion on their face, would you tell them?

I guess most doctors would like to think they would, but what if you’re in a country where there is poor access to healthcare, where medical treatment is only available to those who can afford to pay for it, would that change your decision?

If you tell someone they potentially have an invasive form of skin cancer and they have no means to get it treated, surely you are doing the same as screening someone for a cancer that has no treatment.

I was faced with this very dilemma a few days ago, but I’m not in a third world country, I’m in one of the most developed countries in the world. I was on a subway train when I spotted a man with a suspicious skin lesion on his face, I took a few glances and was certain it was a basal cell carcinoma. He looked unkempt and was wearing torn, dirty clothes.

He certainly didn’t look like the kind of person to have an expensive healthcare insurance policy. I got up to approach but then hesitated, this wasn’t England, there was no NHS here, no equivalent to the free at the point of delivery, that is based on clinical need, not ability to pay system that I’m used to.

$145,000 for a 5 day hospital stay

A friend of mine, a resident of this country suddenly developed Wolff-Parkinson-White syndrome and had a 5 day hospital stay and a catheterised ablation and was charged $145,000.

I can’t even imagine that amount of money, nevertheless having to spend it for a condition that suddenly presented completely out of my control, my friend certainly doesn’t have that kind of money.

So what if you’re in this stranger’s position, what if you’re out of work and travelling on public transport, minding your own business and someone tells you that the lesion on your face, could be invading under your skin, doing irreversible damage and you have no money to pay for the treatment.

You’ve gone from oblivious to knowing that your own body is eating away at itself, and you’re powerless to stop it.

Why do we shut away death?

I’m very lucky to have access to experiences which most people will never see.  As part of my training I have dissected bodies and observed postmortums, both of which teach students about essential anatomy.

Mortuary slabs reveal just how unpredictable and unfair death can be. Image: todmaffin

Whilst doing so they also give an invaluable insight into death, death is random and unpredictable, we all think we will make it to the UK’s average life expectancy of 79.4 years of age, but as the mortutay slabs will tell you, not all of us will.

Death is incredibly upsetting because it has no conscious, it takes everybody: babies, children, pregnant women, young parents, absolutely anybody can die at any age.

I have seen the bodies of people just twice my age, and I’m only 25.  I have seen the blackened lungs of heavy smokers, the fatty organs of the obese and the huge hearts of the hypertensive.

We spend millions on health promotion a year, but blimey march a few smokers and junk food addicts into the morgue and after setting eyes on a cold dead body with organs so diseased they lie dead at such a young age and I’d dare anybody to continue their habit.

The dying are hidden from society

But people don’t see death, it’s seperated from us, when a friend or an acquaintence starts to die they are taken away from society, they die at home, in a hospice or in a hospital with just their very closesst family around them.

Only the minority of the population who have watched somebody die know what it’s really like, and it couldn’t be further from the Hollywood death we are used to seeing in the movies.

To die your body needs to shut down, your organs need to stop working and your body processes need to cease, in the majority of cases you don’t go from talking dearly to your loved ones to death, there is a lot of detioration inbetween.

As soon as a death happens, we go back to the open process, beautiful flowers surround a carved wooden box, the relatives are distracted from the pain and the suffering and for the acquaintences shut away from the death, it’s as if it never happened.

This mechanism protects people from the reality of death but do we not need some perspective?

I can imagine the friends of one of those I’ve seen, sitting around talking about their shock that he died so suddenly and then going back to eating their all day breakfast in the pub, without a second thought to what the dangerous lifestyle of their friend did to him, and what it could be doing to them.

There’s only one person I’ve seen who wants to take this message to the masses, Gunther von Hagens, the German anatomist who had dissected live on television, who wants to show the masses how the body works and just why we need to keep is as pristine as possible.

Von Hagens has put up exhibitions of human bodies in major cities all over the world, to alleviate the gap between the living and the dead, sadly he revealed this week that he’s dying of Parkinson’s disease, I just hope his death won’t lead to the world becoming even more shut off from death to the extent it stops us from living as long and as well as we could.

Image: todmaffin

The Social Network: Does Zuckerberg’s character have Aspergers?

The Social Network is a film which portrays Mark Zuckerberg’s life as he creates Facebook and the subsequent lawsuits which followed.  Zuckerberg’s character is portrayed as someone who has issues with social interaction which raises questions about whether he has Aspergers syndrome.

Image: angus mcdiarmid

The portrayal of the main character is the reason viewers are so drawn in, Zuckerberg has dismissed the film as “fiction” so when I refer to Zuckerberg I will be referring to the character in the film and not the actual person.  The film deals with a real life issue as many have suggested Zuckerberg’s character is on the autism spectrum.

And there are numerous reasons for this suggestion.  Throughout the film the character doesn’t make eye contact, in fact the character is usually preoccupied in something and sees no reason to leave the activity to look at someone.  He frequently looks out the window and in one instant comments on the weather.

His body position is often inappropriate for a social interaction, despite being in a court room the character continuously slouches in his chair.

With regards to peer relationships Zuckerberg is depicted as somebody with only one true friend, despite the importance of maintaining this friendship the character frequently lacks the ability to consider the effect of his behaviour.

For instants Zuckerberg sees no reason not to decrease his friend’s share in Facebook from 30% down to 0.3%.

Lacking emotional reciprocity

He also lacks emotional reciprocity in relationships, the movie starts with his girlfriend breaking up with him after he says she doesn’t need to study due to the school she goes to and then insults her by saying he could introduce her to people she would otherwise not meet.

The character then has two opportunities to rectify his behaviour, firstly immediately after the event, instead he writes an offensive blog about her.  And secondly on a chance meeting with her sometime after where he completely lacks the ability to apologise for his actions and instead tells her about the website he’s making.

Zuckerberg is also not capable of sharing enjoyment, he arrives at a party not to be with his friend but to tell him about his idea and then leaves stating that a looped video of Niagara Falls is distracting him.

The character can become easily preoccupied this is clear through his ability to “wire in” a concept Zuckerberg created where he is so involved with computer coding that he is oblivious to that happening in his surroundings.

Despite the many reasons for believing the character has Aspergers there are many to suggest he does not.  He creates social situations on his level, for instants a drinking game of computer coding and taking shots.

Emotional awareness

And in a single, all-encompassing moment the character shows a great deal of emotional awareness when he finally adds his exgirlfriend to facebook.  On a number of occasions throughout the film it is clear that he has never forgotten her and in this scene viewers are lead to believe the character is sorry for his behaviour.

Similarly some of the character’s interactions with his best friend suggest that he is emotionally aware of his actions on a number of occasions, such as in a scene where he tells his friend he doesn’t want him to get left behind.

Whether or not the character is meant to have Aspergers it’s clear the film has gone to a great deal of effort to highlight the character’s difficulty in social situations, in doing so it has done a fantastic job of emphasising an important issue through mainstream media.

Intrigued? Well to read my review of the film click here.

Image: angus mcdiarmid

Why medical students don’t protest

Reading the thoughts of an NHS doctor who wrote about his disappointment that none of his medical students protested about a rise in student fees, I wasn’t at all surprised.

Medical students are too scared to protest out of fear they will be discriminated against.

With a fire extinguisher being hurled at policemen, a young man with cerebral palsy being pushed from his wheelchair and dragged across a street and kettles leaving young people trapped in freezing conditions for hours, is it any shock that medical students who are CRB checked and need to have a clean criminal record stay away?

Being a final year medical student from the pre-top up fee era, my education has cost around £1,200 a year in tuition fees, add that to: accommodation, books, food, smart ward clothes, petrol and car running costs to get to placements and general living costs and I’ll be starting my first job in around £42,000 of debt.

During my first job I will earn a basic salary of £24,000 a year, being in this much debt on a very average salary absolutely terrifies me, however future medical students look set to be a whooping £54,600 higher in debt than me (£63,000 in tuition fees based on seven years at university).

£63,000 debt only to work for the NHS for the rest of your life

Medical students don’t deserve that sort of debt when they will spend the rest of their lives working for the NHS.

This fee rise won’t affect me as I’ll be graduating soon but as someone who struggled through education as I’m the first person in the family to make it to university, I dread to consider, that had I been born a few years later, I may simply have had to give up my dream.

I wish that I could show my support at the protests but I can’t due to a combination of timetabled hospital duties and being absolutely petrified that my face would appear on the news amongst a small number of troublemakers and could affect me for the rest of my life.

“Professional suicide me thinks”

We live in a time when too much emphasis is put on doctors being perfect both outside of their job as well as inside, to the extent that I felt I had to get permission from my medical school and anonymously from the GMC just to go on a reality television show during my summer holiday.  But that didn’t stop certain acquaintances coming out with comments such as:

“Can u believe sunshine’s in it. omg! professional suicide me thinks”

“I don’t think I’ve ever met anyone whose actually made a decision they’ll regret for the rest of their life”.

It doesn’t matter that I have passed my exams, that I have glowing reports from consultants I have worked under and that I really care about my patients.  Because we live in an age where proving you are an actual human being on television in your own time or marching in a protest which turns nasty through no fault of your own, could harm your career despite having all the qualities that patients want in a doctor.

When I asked my medical school for permission, the doctor I spoke to said it was a sad thing that students felt they couldn’t do what they wanted in their own time for fear of fitness to practice issues.  And in his words: “We’ve had a Miss Wales, we’ve had sporting achievements and now we’ll have you.”

I will always believe in the notion that if I get brought before a panel to discuss something as trivial as peacefully protesting or an appearance on tv, then I would insist that every single doctor in the country with any form of a criminal record is stuck off before me.  I hope other medical students take the same viewpoint and are brave enough to attend the protests.

McDonalds to help write health policy

Burger chain McDonalds is to join forces with health experts to help write new policies on UK health as part of a plan to tackle obesity, alcohol and diet related diseases.

McDonalds are to help write UK health policy

Other companies are also in on the action such as: KFC (the makers of fried chicken), PepsiCo (who manufacture sugary drinks) and Unilever (who amongst other brands are responsible for pot noodle and Ben and Jerry).

Also getting involved are Mars (who make those chocolate covered caramel bars) and Diageo who are responsible for wines, spirits and beers such as Guinness.

So how are they getting involved in health policy, well five  “responsibility deal” networks have been set up whose members will include employees of the companies.  They have been invited to suggest measures to address public health.

Working alongside them will be consumer groups like CancerResearch UK and Which? (probably more the kind of people who you would expect to be involved in polices to tackle preventable health problems).

Wide range of people involved

So what do the Department of Health say about this decision? Well they told the Guardian that they’ll be engaging a wide range of people for the next white paper such as businesses and local government.

The problem people have is that white papers have the nation’s health as their best interest whilst industry had profit as their best interest.  I mean what could a company famous for selling fries and burgers have to say about tackling obesity?

There would be outrage if we asked Benson & Hedges and Marlboro to comment on smoking related diseases so why is this not being nationally condemned?

In my opinion the public have yet to see the effect problems such as obesity will be causing in the future because they have only seen the consequences on a small scale to date.

Should a doctor be expected to paralyse a healthy man?

A Saudi judge has asked doctors if they would be willing to paralyse a man.  Putting a huge weight on doctors who are governed by the principal: “First do no harm”.

The man concerned attacked and paralysed a 22-year-old man, he served just half of his 14 month jail term, the victims family asked for an “eye for an eye”.

The judge has so far asked if several hospitals would perform the punishment and so far none have agreed.

The Hippocratic oath which originates from the 4th century B.C.E tells doctors that if nothing else they should ensure they do not harm their patients.

But in modern times doctors are expected to perform punishments.  Lethal injections are performed by doctors frequently and in this recent case doctors are being asked to go a step further and perform surgery to paralyse a healthy man.

Just what is the way around this issue? As a future doctor, I certainly wouldn’t want to be involved in the injuring or killing of a person even if they had broken the law.

But could I be breaking the Hippocratic oath?

If all doctors refuse to perform punishments will the punishments stop or could it risk punishments being left in the hands of those who are unqualified? If the latter, then surely the doctor’s decision is putting a patient at risk of harm.

Stilettos vs pain

Cosmetic foot surgery is dominating the news but is this type of surgery really that helpful?

Women are undergoing cosmetic surgery in order to fit into stilettos

The “Cinderella procedure” is a preventative bunion operation popular at the Beverly Hills Aesthetic Foot Surgery.  More and more women are undergoing such operations in order to fit into a tiny pair of heels.

Having grown up with congenital hallux valgus (a form of bunion) and undergoing corrective surgery at 15 years of age I know only too well what it’s like to be unable to fit into a pair of high heels.

I was mocked by a shoe website for entering and leaving the Big Brother house in the same pair of shoes as I only have the one pair that I can wear comfortably, despite this I won’t be undergoing surgery.

Feet seem simple enough but they are actually rather complicated structures, it took me months to learn to walk again following the medical procedure I had.

What’s more, messing about with one joint can lead to referred pain at another which is the warning podiatrists are giving women before they consider undergoing this procedure.

If you are thinking about undergoing surgery to fit into a pair of shoes you should decide if it’s worth the pain that could arise for the pleasure of wearing those stilettos.

In my opinion shoe manufacturers should start making shoes available in sizes which fit onto real peoples feet before women start adjusting their feet to fit into heels!

Life saved by blinking eye

This week a documentary captured the moment that paralysed Richard Rudd told doctors he wanted to live by blinking his eyes.

Locked-in syndrome can leave blinking as the only means of communication. Image: Filomena Scalise

It halted a decision from his family to turn off the life support machine which was keeping him alive.

Richard suffers from locked-in syndrome, he is awake and aware of his surroundings, but is paralysed so he can’t communicate.

Total locked-in syndrome is the paralysis of every part of the body making communication impossible.  In some cases, such as Richard’s, patients can still control their eyes.

Jean-Dominique Bauby also had the condition, the former editor of French fashion magazine Elle suffered a stroke.

Despite the illness the journalist wrote a book called The Diving Bell and the Butterfly.  A friend read through the alphabet and Bauby blinked at the correct letter to transcribe his memoir.

Image: Filomena Scalise / FreeDigitalPhotos.net

UK best for end-of-life care

The UK has been ranked top for provision of end-of-life care in an index drawn up by the Economist Intelligence Unit.

End of life care has been ranked at the top of 40 countries throughout the world. Image: vitasamb2001

The index ranked 40 countries on their treatment of the dying and because of palliative care, hospices and the access to pain killers, the UK ended up at the top.

Shockingly 8 per cent of people around the world don’t receive palliative care.

Palliative care in the UK involves supporting patients and their families when they are facing life-threatening illness.  The National Institute of Clinical Excellence believe this should include:

• Treating dying as a normal process
• Providing pain relief
• Supporting patients and their family
• Including psychological and spiritual aspects of care

Image: vitasamb2001 / FreeDigitalPhotos.net

Fit notes instead of sick notes

GPs will be providing fit notes instead of sick notes to get staff back into work from April 6th.

GPs will soon be providing fit notes, that state what duties a patient can do.

The new notes will state the duties a worker can carry out. It is then up to employers to accommodate the staff member so they can perform those parts of their job.

The principal is that work aids a person’s recovery and prevents isolation and social exclusion.

The fit notes will apply to people who are off work for seven days where a doctor believes extra support would help them return to work quicker.

I wonder how this will apply to psychiatric conditions like stress and depression.

Image: Suat Eman / FreeDigitalPhotos.net