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

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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.

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.

Doctors have called for a ban on smoking in all vehicles because of a rise in the incidence of asthma in children but are confusing new laws really the way to help?

Passive smoking causes childhood asthma but does that mean it should be banned in all vehicles?

On the subject of the report, it found that smoking around children leads to:

  • 300,000 appointments with GPs
  • 9,500 hospital admissions
  • A cost of £23.3m each year

The figures are shocking but is banning smoking in cars really going to make much difference, is it not just going to lead to laws which are difficult to police?

Health promotion is a difficult task. There are two ways of preventing conditions developing. The first involves educating a person with facts, so explaining to parents the effect smoking has on their children.

This was done fantastically with this video:

The second way is to force people into making choices with laws, but without accomplishing the first method the laws will be difficult to enforce. People need to know that there is evidence supporting why a law should exist or they simply won’t abide by it.

The problem is that the Royal College of Physicians (RCP) who made the report don’t just call for a ban on smoking around children but for all drivers regardless of if a child would never sit in their car.

There is obviously no scientific proof that banning smoking in a vehicle that doesn’t carry kids is going to prevent childhood asthma so Prof Britton from the RCP justified a full ban by saying that if a driver doesn’t ferry kids around they should still get out of the car before lighting up for road safety issues.

Now I’m not saying that smoking while driving is 100% safe but surely if a law is going to be made it should be in line with the research available?

Image: Salvatore Vuono / FreeDigitalPhotos.net

Days after Alan Johnson announced a ban on the former legal high mephedrone another member of the Advisory Council on the Misuse of Drugs (ACMD) has stepped down, bringing the total to seven since Professor Nutt’s dismissal.

Another expert has quit over a ban on the legal high, mephedrone.

A few days ago Dr Polly Taylor, the veterinary expert on the ACMD panel stepped down saying that laws shouldn’t reflect the media’s mood of the day.

Despite the panel being short of the veterinary expert it required Alan Johnson went ahead with a ban saying that he had taken advice from the ACMD.

Today Eric Carlin who is also the Chair of the English Drug Education Forum announced he is quitting the council. He reproduced his resignation letter on his blog, in it he wrote:

“We had little or no discussion about how our commendation to classify this drug would be likely to impact on young people’s behaviour. Our decision was unduly based on media and political pressure.”

The council, which only contains 23 members has lost seven since Professor Nutt’s dismissal.

After the deaths of two teenagers who had taken mephedrone there were calls to ban the drug.

The ACMD needed to collect and analyse research before giving the government advice. Eric Carlin’s resignation does little to reassure the public that the government took advice from scientific evidence and not the media.

Last week the so called Dr Death entered the UK for the purpose of providing “Safe Suicide Workshops”, he did so as a climate of fear hit doctors after new guidelines stated that doctors could be prosecuted for assisting their patients with suicide.

New guidelines on assisted suicide have put doctors at risk of prosecution

The guidelines which were released last month provide a list of circumstances which will be taken into account when deciding if cases should be brought.

So where do the new guidelines leave doctors?

Well the new proposals include a section arguing in favour of the prosecution of doctors, which was not included in the original proposals.

Also if someone is unknown to a victim and assisted by providing specific information to assist someone in committed suicide, then a prosecution is more likely.

Furthermore it is more likely if someone gives assistance to more than one victim who are not know to one another.

So not only do these guidelines risk prosecuting doctors who run workshops on suicide but it also places the average general practitioner in a very difficult position.

Patients could ask doctors for advice about suicide, they must not engage in discussion or prosecution could potentially be brought.

Also patients with chronic or deliberating illness may require a medical report before they can travel. If they are requesting this so they can travel to a country where euthanasia is legal then the doctor has effectively assisted their suicide and could be prosecuted.

Dr Nick Clements head of medical services at MPS told Pulse Magazine:

“We are advising GPs who have even the slightest suspicion that their patient may be planning an assisted suicide to proceed with extreme caution and not to comply with requests for medical or travel reports in these cases.”

But will the risk of prosecuting doctors not lead to further problems? Doctors have a position of trust, if they are constantly questioning the chronically ill whenever they want to travel out of the country is it not going to create more harm than good?

Vulnerable British citizens are not protected from the law of other countries despite possessing mental illnesses.

A British man who suffers from a mental illness has been sentenced to death in China and may be put to death as soon as Tuesday.

Akmal Shaikh travelled to China following the delusion that he could become a pop star. The charity, Reprieve are claiming that his mental illness left him susceptible to people who tricked him into carrying heroin.

His family have travelled to China to insist a full mental health evaluation should be performed. But why hasn’t he undergone a psychiatric examination already?

How can a person with a past history of bipolar disorder and delusions be treated as a healthy individual who has maliciously committed a crime?

And just why can’t Britain look after its own?

According to reports Gordon Brown and David Miliband have attempted to prevent the execution. But it seems that China is still going to go ahead and kill a delusional man.

The song Akmal Shaikh recorded beleiving it would bring him fame.

This video belongs to the charity Reprieve

The case runs in parallel with that of Asperger’s sufferer Gary McKinnon. Gary hacked into US military computers whilst looking for evidence of UFO’s. America applied to have him extradited for trial. The high court failed to prevent his extradition. And now his only hope lies with the European Court of Justice.

If the Brit is sent to America he could face 60 years in prison. More worryingly Gary has suicide tendencies and the stress he is under could lead to him attempting to end his own life.

So just why does Britain lack the ability to protect it’s vulnerable citizens? Does the rest of the world have so little respect for the UK that countries can do as they wish with our mentally ill?

You have to question just what the rest of the world currently thinks of the UK.

Bill Clinton made an unexpected trip to North Korea earlier this year. He travelled back to the States with two American journalists who had been imprisoned for entering the country illegally.

And Gordon Brown can’t even prevent a mentally ill British national from being put to death.

Image: Salvatore Vuono / FreeDigitalPhotos.net

This week the sexual assault and harassment case against gynaecologist, Angus Thomson was dropped. Bibi Giles had accused him of sexually assaulting her during an intimate examination.

This was despite a nurse chaperone presence. As the defense had not yet sat the nurse didn’t have the chance to testify.

It was clear to anybody who followed the case that the whole fiasco was absolutely ridiculous. How could the case have even got to court when there was a chaperone present?

The accusations became even more unbelievable when it was revealed Bibi had attempted to start a relationship with the consultant and had even sent the doctor a sexually explicit and inappropriate text message.

Married Bibi Giles dropped her case after her former GP stepped forward claiming she had made similar advances towards him.

I am so disgusted that the case went to court. I’ve experienced the effect these kind of court cases have on doctors.

Being female I’ve been asked to chaperone male doctors on numerous occasions. If there isn’t a female chaperone present a male doctor cannot take the risk of examining a woman regardless of the seriousness of the patient’s potential condition.

For three years Mr Thomson has been subjected to the ordeal from Mrs Giles.

Bibi was described as a “fantasist” after it was revealed she claimed to have once been Miss Guyana, had treated Michael Jackson and Oprah Winfrey. She even insisted her husband was a Russian diplomat (he was a quantity surveyor).

What has happened to the sacred doctor-patient relationship? How can a woman make advances to a married doctor and when they aren’t reciprocated accuse him of sexually assaulting her in a medical consultation? And more importantly how could this case have gone so far?

I honestly hope Mr Thomson can return to his job as he did before. But it is likely the effect of this case will remain with him and he could be scared this kind of incident could happen again. It’s a sad day when someone who dedicates their life to helping people cannot do their job for fear of people like Bibi.

Image: renjith krishnan / FreeDigitalPhotos.net

A new report outlines flaws in the hospital care of dementia patients

A report has been published from the Alzheimer’s Society, pointing out a number of flaws in the hospital care of those with dementia.

It comes just a week after the news broke that patients with dementia are being prescribed antipsychotics inappropriately and the subsequent side effects lead to 1,800 deaths a year.

Dementia, is the global impairment of mental functioning, this occurs in a clear consciousness and is usually progressive.

The condition is usually caused by cerebrovascular disease (a problem with the blood vessels in the brain e.g. a stroke) or Alzheimer’s, the cause of Alzheimer’s is unknown but it is likely to be due to genetic factors.

Dementia affects a person’s memory and causes them to become disorientated, the person’s awareness is lost and the disease also changes a person’s personality and behaviour.

The combination of symptoms places pressure on the staff responsible for the care of dementia patients.

The report form the Alzheimer’s Society outlines failures in the care of dementia patients and was determined by questionnaires from over 2,000 carers and nurses.

It stated that people with dementia occupy 1 in 4 hospital beds and they stay longer in hospital than patients without dementia. Not only does this cost the NHS but it has a negative effect on the patients symptoms and physical health.

More than 1 in 3 dementia patients are discharged to a care home despite living at home prior to admission.

1 in 4 nurse managers and nursing staff felt antipsychotic drugs were inappropriately prescribed.

Carer’s determined the main problems were, a lack of:

  • Understanding of dementia by staff
  • Individual care
  • Help with eating and drinking
  • Social interaction
  • Involvement in decision making
  • Dignity and respect

Nursing staff felt the main concerns were:

  • Managing difficult behaviour
  • Communicating
  • A lack of time to spend with patients

The report suggests that the number of people with dementia being cared for in hospitals should be reduced. This means funding should shift into community care.

It also suggests carers, friends and family should be involved in the care and decision making process. And a individual care plan should exist for each patient, which focuses on the patients likes and dislikes.

Image: Simon Howden / FreeDigitalPhotos.net

By Yvette Martyn

An Ofcom type agency is required to regulate cosmetic surgery according to the journal, Clinical Risk

The medical journal “Clinical Risk” has devoted its issue to aesthetic surgery aka cosmetic surgery. The journal concluded that the media, advertising and promotions cosmetic surgeons use are potentially unethical.

The president of the British Association of Aesthetic Plastic Surgery, Nigel Mercer, combines a consumer market who believe “new is better.” With the expectation that there are no adverse outcomes from cosmetic surgery in his editorial in the journal.

Cosmetic surgery is incorporated into modern society. It’s almost impossible to think of a celebrity who hasn’t had surgery, and there are many horror stories out there:

  • Jordan, who needed physiotherapy to bring back the sensation in her paralysed arm, following breast surgery.
  • Pete Burns, who reacted badly to injected lip fillers.
  • Kayne West’s Mother, who died of complications following cosmetic surgery.

So when the rich and famous, who hire the most experienced surgeons, see the side effects of operations, why do the public believe they are protected?

The problem with cosmetic surgery is that it goes against the philosophy doctors live by, the principal rule of medicine is:

“First, do no harm”

Doctors became a profession because they are above commercialism, they are not out to make money, for example, no doctor would advise an inappropriate c-section to make money. They have control over the market and the dominance to state what counts as illness. Doctors also possess specialist knowledge and exist in a community with tests and rules.

But cosmetic surgery goes against all these factors and this can leave the public with the problem. The public must judge if they need cosmetic surgery whilst being wary of the surgeon, and whether they are advising on the basis of making money.

The journal suggests an Ofcom type regulator is required. This would ensure the words of Nigel Mercer:

“If we have to sell anything, we should sell out advice, not procedure”

Image: Aleksandr Kutsayev / FreeDigitalPhotos.net

By Yvette Martyn

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6% of 11-17 year olds are using tanning beds despite the risk that they may need to go under the surgeons knife as a result

Cancer Research UK stated that 6% of 11-17 year olds are using tanning beds in England. I started using tanning beds when I was 17 and continued using them until a few months ago when I chose to do an attachment in dermatology.

I remember watching patients having large chunks of cancer cut out of their faces, with flaps being used to cover the loss of tissue. The resultant permanent scarring and risk of death put me off tanning and I immediately stopped.

It didn’t take long until I realised what had made me start in the first place though. Society places huge amounts of pressure on young women to remain a colour to die for.

A month after giving up tanning, I received a text message from my local tanning salon, a salon which belongs to a national chain.

“Hi Yvette, we’ve missed you at the *** in June, and just to show you how much have a 1/2 price tanning sachet on us.”

I couldn’t believe it; tanning has been proven to be a risk factor in the development of cancer. It would be absurd to offer an ex-smoker a half price packet of cigarettes so how is it logical to dangle an offer to an ex-tanner?

I ignored the text but my anger grew when I went to my gym, the gym was also part of a national chain, a chain which emphasises the belief that health should come first.

Persuaded into tanning at the gym

The receptionist asked me if I wanted to go tanning as they had a promotion on. A man was dressed in Hawaiian get up, walking around the gym and offering people the same offer.

I don’t understand how a gym that exists to promote good health could try to persuade people into undertaking a dangerous activity. It just didn’t make logical sense.

The main issue is that; I have spent years studying medicine, I know what causes skin cancer, I know how to prevent it and I know the consequences when you get it. But, I still continued to go tanning for six years.

I can now turn a blind eye to these offers but can people that aren’t aware of the consequences?

People who haven’t seen the crying relatives and the shock on the face when the person looks in the mirror at their disfigured face. I certainly believe 11-17 year olds won’t fully understand the consequences of tanning.

There are associations which represent tanning salons and they state that the majority do turn away under 16’s. But, in my opinion, legalisation would be the only way to prevent young girls exposing themselves to such a dangerous activity.

Image: Simon Howden / FreeDigitalPhotos.net