Mini Medical School 2014

Newcastle University annually host a lecture series for students who are looking to apply to medicine. The lecture series covered a range of topics over 6 weeks, from immunology to forensic pathology. It would take forever to write about all of the interesting things that I have learned, so instead I'm going to go over a few things I found particularly interesting.

How to fool the police with raspberry jam and a dog

A talk given by a forensic pathologist was definitely one of my favourites. He told us a story about a case he had been called to…

'So the police had attended a scene after a man was found collapsed and dead in a block of flats. They had found a suspicious red pool stain on the pavement in an alley about 300 meters from the house followed by a blood trail all of the way to the body…It seemed obvious to the police what had happened until the body was examined, when it became evident that there were no injuries and the man had actually died of a massive heart attack. So what was the cause of the pool and the drops of blood up to the body?! Well basically, what had happened was that the man had been shopping and bought some raspberry jam. When his chest began to hurt, he had dropped his shopping and the glass had smashed on the floor leaving a stain. Later a man had been walking his dog and the dog had stepped on the glass and cut its paw. The dog walker had then gone to find the source of the dropped shopping and had taken his dog up to the flat and found the man there. So the stain was in fact jam, and the drops were blood, but weren't human.'

I thought this was great and was the epiphany of the phrase 'things aren't always what they seem!'

X-linked carriers of chronic granulomatous disease

This is a sex linked genetic disorder which affects the phagocytes. They are able to detect and isolate irregularities in the body such as parasites, but are unable to inject the chemicals into them to kill them. The treatment for this disorder is prophylactic antibiotics to try to prevent illness from developing and becoming serious due to the defect in the immune system. Because the disorder is x-linked, women are not classed as sufferers but instead are classed as carriers. Until recently, carriers did not receive the same treatment as sufferers until Dr Alex Battersby conducted some research and discovered that often women suffer the same (if not worse) symptoms as men who are classed as sufferers. She explained that this is due to the fact that obviously women have two X chromosomes; one from their mother and one from their father and usually only one has the gene for CGD. Because in the cells of women only one X chromosome is activated, and because the process is random in each individual cell, carriers experience varying levels of symptoms. I wasn't aware that this was the case and found this particularly interesting. It's odd to think that despite the fact that two women have the same gene in the same frequency they could suffer different levels of symptoms. 

Medical physics and games consoles 

I must admit that I'm not a huge fan of physics, so I wasn't overly excited for this lecture but it ended up being one of my favourites. This was probably the most interactive lecture but the content was so interesting. They conducted a few experiments at the front of the lecture theatre. They started by showing us how you could display a ECG using two buckets of water and a wire connected to an amp.  So they grabbed one of their colleagues and hooked them up to the bucket and sure enough, the standard squiggly lines appeared on the screen. But then, the more interesting part was when they altered the frequency of the receiver to measure the electrical impulses in the muscles as opposed to in the heart. They had the man place his arm into the water and a few small lines came up onto the screen. They asked him to tense his arms and the lines on the screen became more frequent and had larger amplitudes. Another experiment they conducted involved an Xbox 1. This game console uses infrared to identify the shapes in front of the console so that gamers are able to use their bodies to control the game. The physicists used this to show us how these waves can display an image in 3D which could not usually been seen by the naked eye. They used a video camera to show the little white dots which covered the person standing in front of the camera in real time as they moved around. They used a programme to take a 'picture' using the infrared to create a 3D image of the man. This was pretty cool but I wasn't really sure how it could be used in medicine, until they started to talk about scoliosis. This is a condition which affects the curvature of the spine and used to require regular X-rays to monitor. With the knowledge that X-rays are dangerous to patients when they are overexposed to that kind of radiation, doctors were reluctant to continue to monitor the condition in this way and agreed that it was necessary to find an alternative. The medical physicists then came to the rescue when they realised that this technology could be used! I think it's crazy that this technology can be put to use in so many ways other than just for gaming. 

I would definitely recommend mini med school to anyone looking to study medicine in the North East or anyone who has an interest in the sciences. 

Can we eliminate genetic disease through better awareness?

This was the question posed at a heretics meet last week. The group consisted of scientists but also other academics, so it was interesting to hear the various arguments and points of view that were sparked by the idea. 

The speaker, a good friend of mine, had named his talk sterilization and stated that he believed that we could considerably reduce the risk of children in the next generation being born with genetic diseases by introducing some simple protocols in the UK. He suggested having the entire population (above the age of 13) screened for genetic diseases to make them aware of their genetic make up and to ensure they are fully conscious of any genes they may be carrying which could be passed on to their potential children. This was the basis of his argument. He went on to state that before people decide to have a baby, the parents could cross their genomes, in a similar way to the way that we do it in Punnet squares at GCSE, to check the likelihood of their child being a sufferer of a given disorder. With this awareness they could then decide whether they would still like to have the child or whether something like IVF, for example, would be a better route for them. He proposed that they should be given 2 chances to have children who were genetic disease free naturally, followed by a chance at subsidised IVF, before they would be told they should no longer reproduce. So sterilisation would only be used in cases where people tried to cheat the system and continued to reproduce despite the fact that the children were suffering from genetic diseases and realistically the use of this title was an attention seeking stunt and he himself admitted that.

Of course the heretics society got hung up on the fact that he had suggested preventing people from having children, which to them seemed unfair, and in fact probably is. However, the main focus of his argument was actually pretty strong. If we consider the cost of sequencing a genome compared with the cost of treating a patient with CF for a lifetime, for example, the healthcare system could definitely benefit from taking measures to reduce the instances of these genetic diseases. Given that it could be fairly simple to determine probabilities in terms of the offspring suffering from the genetic disease. I would like to think that if people were aware of these probabilities, parents would consider this as a factor in their decision to have children. This being taken into account, I think it is likely that we would see a decrease in the incidence of genetic disease in the next generation purely through raising awareness. Of course the process would be expensive to implicate at first but I would see it as being similar to a vaccination program, such as the flu jab, which is offered to those who need it every year. This would be the case with the screening in my opinion. Every child who had turned thirteen in the past year (after the first year, of course) would be screened.

Something to consider, however, would be genetic diseases such as Huntington’s, which would not affect the sufferer until much later in life, but are also known to have no treatment. Some people may opt not to be screened because they would rather not know, and we need to consider that this is their right. However, this would interfere with the whole system and could affect the population in that the disease may be passed on to the next generation in an instance where it may not have been if protocol had been followed. We must think about the balance between ensuring that everyone’s rights are fully taken into account and making sure that the process is effective and of course cost efficient.

But obviously it shouldn’t be all about money. (Even though a lot of the issues in the NHS nowadays are…) We must ask ourselves if we think it is acceptable that children still wake up with Tay Sachs disease when this could have been prevented by a simple screening program to give parents the awareness they need to make informed decisions. We should be conscious of the suffering that comes with most genetic diseases. I watched a documentary recently based in a hospital in Newcastle, which is very local to me, and it really touched me. It followed several children who were in hospital for various different reasons, but one particular boy’s story, who was a sufferer of CF, particularly struck me. This young boy was about 12 and wanted to go to a sleepover at a friends house for his friends birthday, but because of his disease, was unable to sleep without oxygen at home and his friend’s mum didn’t want the responsibility of regulating and monitoring his oxygen through the night. So during his stay in hospital, he worked extra hard and attended physio sessions in order to try to clear his lungs enough, and gain enough fitness to be able to go an entire night with no oxygen. I, personally, had never thought about not being able to sleep without a machine being attached to me, let alone the things that go with that, such as the fact that he couldn’t stay at friends’ houses. As a child who grew up healthy and was always able to do everything I wanted to in terms of physical and mental ability, I can’t imagine living life as a young boy the way he has to. But this is completely unnecessary! We could reduce the risks of people being affected by these issues fairly easily if we were to introduce a simple awareness program to the population.

Of course there are lots of flaws in this idea, as there are in all new concepts, but I really do feel this is something that we could consider, or at least offer to potential parents to reduce the suffering of their offspring.

Diagnosis and Budgeting

 I have attended several talks in the past few weeks on various topics but all of these seem to have had one thing in common; the fact that budgets and quotas play a huge part in the role of a doctor.

The first in this series of talks was a talk given to my school’s medical society by Dr Greg Rubin from Durham University about the early diagnosis of cancer, in particular the role of GPs in the process. He stated that a quarter of cases of cancer are diagnosed in A&E and also that in terms of survival rates after diagnosis, the UK looks pretty bad compared with other countries including Denmark, the USA and Australia. The UK currently has 28 cancer care networks but this doesn’t seem to be enough. We were able to ponder the importance of a multitude of factors influencing the chances of survival of a cancer patient but the winner was always going to be the time of diagnosis. So how can the NHS ensure that diagnosis takes place early enough?

A few factors were mentioned:

-The ability of patients to recall significant symptoms that are often unknown, such as a persistent cough. Failure to mention something that may seem trivial to a patient due to a lack of knowledge on the topic could mean a doctor misses a diagnosis, which could save a life. This highlights the importance of awareness of common symptoms of various cancers. It becomes slightly difficult, however, to fully educate the population when we consider that there is a fine line between education for the good of the population and education that could cause panic and be seen as scaremongering. For example, the last thing busy, overprescribed, understaffed hospitals need is Mrs Smith who has had a cough for two days and is convinced she has cancer walking into their emergency department demanding tests. We also need to think about the fact that education of an entire population is not going to be cheap and can the NHS afford all of the campaigns that would be necessary to publicise the unknown symptoms of less common cancers? Should cost come before the health and awareness of the population? Would it in fact save money to educate people and thus reduce the number of emergency cancer cases seen by catching it earlier?

-This brings us nicely to the second factor; the early diagnosis of cancer. Of course identifying cancer in patients early will increase their chances of survival. So what is involved in diagnosing cancer in a patient? I attended Mini Medical School at Newcastle University where the topic was ‘Diagnosis-art, science or hunch?’ and the diagnostic process was also touched upon in the lecture given by Dr Rubin. There are several steps to diagnosing a patient, most of which do not directly involve a doctor. Before the doctor even sees the patient, the patient has the appraisal phase, where they decide that they are ill and need treatment. This requires knowledge of what it means to be ill. Of course there is the medical model of illness, where one has a disease and is suffering from symptoms. Then there is the general state of health, both mental and physical whereby general wellbeing would be defined as healthy. So the patient decides that they are unhealthy but does not necessarily head straight to the GP but might first consult a friend, member of their family or self medicate, for example just take a paracetatmol. But this doesn’t work so they decide that they need to go to the doctor. They may not give the doctor all of the relevant information and are generally worried about the outcome of the appointment, so it's fair to say that the doctor has a difficult job ahead of them. Not only do they have the responsibility of this person's health being entrusted to them, they also have the healthcare systems rep to uphold, especially after incidents such as the MidStaffs enquiry. But added to all of that, they have budgets to stick to. Does this put them off taking potentially necessary tests? Would they take a test if they had unlimited money to do so? Would they refer more people to specialists if there wasn't a huge waiting list?

The main question we need to ask in these cases is is the quality of care restricted by a lack of resources? And the obvious answer is yes but more importantly, what can we do about it? 

Horrible Hormones

I thoroughly enjoyed a lecture given by a senior lecturer at Newcastle University about common endocrine disorders and their biochemical causes. Of course I was already aware of how important hormones are to the body, but the way in which one tiny change can affect the body is truly extraordinary. 

The centre of this talk was obviously the pituitary gland and the way tumours associated with it affect the body. I learned that the pituitary gland is made of two sections with separate functions; the anterior and the posterior. A hormone produced in the anterior called prolactin is associated with the production of milk in mammals and also 'switches off' the menstrual cycle during this process to prevent further reproduction. Without considering this factor, the West decided to send bottled milk to Africa for children to be fed with rather than breast milk from mothers, which meant they no longer required milk which halted prolactin production and restarted the menstrual cycle. This effectively reversed mother nature's contraception and caused a population surge. This is a good example of when meddling with nature can have unexpected consequences, something which should always be considered in medicine. The posterior of the pituitary gland is associated with the production of ADH and oxytocin, but the main disorders discussed related to the anterior. 

The presentation of pituitary tumours seemed to be fairly generic at first, but could be anything from excess/deficiency in hormones to apoplexy in acute cases. They can also cause bitemporal hemianopia; a change in the field of vision due to pressure on the optic nerve or chiasm. Depending on where the gland is altered, there are varying physical effects. 

One disorder is acromegaly, which is an excess of growth hormones, caused by hypopituitarism. An example used by the lecturer was a man called Gary Tiplady who was 7ft3! Because these tumours are so slow growing, the tumours are often not noticed for years, by which time the patient often has many other problems related to pituitary adenomas. This includes Cushing's diseases, caused by an excess in secretion of ACTH and production of steroids by the adrenals glands and can result in conditions such as diabetes, osteoporosis and obesity if not recognised and treated. Another condition could be Addison's (which JFK had) which is often known as tuberculosis of the adrenal glands and presents as increased pigmentation and often also vitiligo, which contrasts massively on the skin. People may have an Addisonian crisis if they have a lack of steroids which is why people who take steroid medication will carry a card around with them stating this. 

We also looked at the thyroid as an area where problems often arise, thinking about both hypothyroidism and thyrotoxicosis. Hypothyroidism is often caused by an iron deficiency, but this cause is uncommon in the UK due to a good supply of iron in the diet. Thyrotoxicosis, however, is the opposite and can result in conditions such as Grave's disease, which is sometimes known as thyroid eye disease due to an antibody causing inflammation of the eye, meaning the patient often sees double. Grave's disease can also cause atrial fibrillation due to the overactive thyroid and this was exhibited in George Bush senior, when he collapsed on a golf course while in office as president as a symptom of his condition. This can be treated with inhibition of hormone synthesis orally or in extreme case with thyroid surgery. Alternatively, and more commonly in more current medicine, it can be treated with radioiodine, which is taken by the patient and ablates the thyroid. The patient is then given hormone replacement therapy to maintain the correct hormone balance usually controlled by the thyroid. 

In the most extreme cases, hormone deficiency can cause pituitary apoplexy, which can present as a subarachnoid haemorrhage, with symptoms such as a severe headache and visual loss. It is vital in these cases that the hormones are replaced as quickly as possible otherwise it is potentially fatal. 

Overall, the talk outlined to me that there are so many things that can go wrong with hormones in the body and it is so important that doctors are able to spot these disorders and treat them effectively. I was fascinated by the variety of conditions and the biochemistry that causes them. I continue to be amazed by the complexity of the human body, where there are so many opportunities for things to go wrong, yet the majority of us are lucky enough to be unaffected by these conditions. It seems almost unfair that most of us go through our lives completely blissfully unaware that these conditions exist and it's purely down to our genes and luck that we are not directly affected by them. It is in these situations where the vigilance and care of doctors, nurses and other medical professionals really come into their own and are able to provide life changing care and treatment. 

Work Experience

Last week I spent  4 days in my local hospital following several very busy doctors around! I was able to spend time in various departments of the hospital.

Surgery

I watched several operations both laparoscopically and open, all of which were extremely interesting. I particularly enjoyed a mini stomach bypass on an obese man. I was amazed by the innovative equipment the surgeons had access to and was fascinated by the intricate manoeuvres they could perform. The bypass was performed in about an hour, with no complications. More than the actual procedures, however, I was watching the interactions between the doctors and scrub nurses. It was interesting to see the team of people working together on the one operation and it really confirmed to me that being a doctor is definitely a job for a team player. I took opportunities to ask the doctors about their lives and their training and one thing that stuck in my mind was when a surgeon told me that if I wanted to make money and be praised then I shouldn't be a doctor, but went on to say that if I wanted to make a difference to people and have good job satisfaction then I was making the right decision. I think I am. I asked him what the worst part about being a doctor was, and he told me it was most definitely the family life (or lack of, for that matter). This is something I'm sure I cannot fully understand, given that I am only 17, and have lived away from my family since I was 14 at boarding school. However, I know it is fully possible to have a family life in the medical profession, it just may not be completely conventional, but that being said, I don't think I would enjoy a conventional life. I think I will enjoy the challenge, being constantly stretched. I also attended a lunchtime meeting with the consultants where they discussed all of the new cancer patients they would be dealing with and the direction they thought their treatment should go in. One of the consultants told me that the reason for this meeting was to get as many opinions as possible and ensure the patient was receiving the best care possible, yet another example of doctors acting in a team.
A&E
I absolutely loved my morning in A&E again! I followed a lovely nurse, who showed me everything there was to see! There were some difficult cases and of course dealing with sudden loss is a major issue in A&E. Something that stood out hugely in A&E was the importance of good nurses and good bedside manner. A lot of the people who came in were distressed and their relatives and loved ones were upset and worried, requiring friendly faces and chatty nurses to take their minds off the hard time they were going through. I enjoyed talking to the patients and laughing with them as they had bloods taken and obs done because I felt as though I was helping them slightly. I was really stretched in A&E where the consultant asked me what I wanted to gain from my morning in her department and I told her I wanted to gain insight, experience and an idea of what it's like to be an A&E doctor, but also to be challenged. She rose to that straight away and handed me a case of a man who had been referred to A&E by MIU for them to then refer him to the specific department he needed. She asked me how efficient I thought this was and if I could think of a better pathway to go through. Well… It was 9am on a Tuesday morning and I had definitely been thrown in in the deep end but I loved it. I told her I thought it was very inefficient given that A&E had nothing to do with this particular patient until they were given his file by MIU, which seemed an unnecessary link if only
Cardiology
The cardiology department was probably my most challenging stint (stent ;) haha) in my work experience because it required a good level of understanding about all of the areas of the heart and the blood vessels around it. Luckily, this was my favourite chapter of the biology course, so I looked more into it! Thank goodness! I watched the procedure performed with catheters to investigate a stenosis in a lady's coronary artery and discussed with the doctor the procedure to insert a stent to widen the artery to prevent an MI. The doctor then took me to an audit meeting about a new blood thinning drug. He explained that this drug was better than Warfarin because with Warfarin, the blood needs to be tested regularly whereas with this drug, testing is much less frequent. This is positive because it means the drug has less of an impact on the patients life.
Interventional Radiology
Nowadays, surgery itself is much less invasive because of the fantastic advances in technology, and this includes certain operations which now don't even need to be operated on as such. They can be performed with ultrasound or X-Ray assistance. I watched a procedure where a lady had a gall stone stuck in her bile duct which was causing blockages and infection, but the woman was old and the risk of removing the gall stone, along with the stress it would cause her to have to undergo surgery, was deemed to not be worth it. So instead, the doctor used ultrasound to direct him to her liver, gave her a local anaesthetic, and used a needle to go through her liver to find the stone. He used dye which could be seen on a screen to be filling her bile duct, and the stone was so obvious. He then used the needle to guide a wire, over which he could pass a tube, to act as a bypass around the stone. This would prevent it from causing anymore blockages and less infections. The procedure took no more than 20 minutes! The personal side of this was more difficult than most of the others I watched, because the lady had dementia, and was very upset, asking why we had done that to her. She was crying and would beg me to let her go home and make her stop, reaching her hands out to me. I must admit, I wasn't overly sure how to approach this situation, given that I knew she couldn't go home just yet and was in no position to help her. I found it so hard to see her in pain the way she was, both emotional and physical. However, I was so touched by the way the other professionals in the room dealt with her and reassured her and calmed her down. They were so kind, patient and compassionate with her, which is exactly the type of doctor I hope to be one day.
Neurology
The final department I visited was a ward in neurology where I saw a lumbar puncture! I noticed on the ward how attentive the nurses were to the needs of the patients but also, how much administration the doctors had to! There was a lot of paper work and less patient contact that I expected. The doctors spent  quite a lot of time looking at scans and discussing treatment plans as opposed to seeing patients. I still enjoyed this though, because I was able to see lots of scans. 

Bad Science, Ben Goldacre

In my opinion, this book can be described as nothing other than brilliantly eye opening. Ben Goldacre discusses serious issues faced by the public, including medical professionals with a fantastic sense of humour and flair. I seriously enjoyed reading his book.
I enjoyed his chapter about Gillian McKeith, but that was mostly due to his whit as opposed to the science based knowledge he wrote about, which was definitely not lacking in other areas of the book. To start with, he debunked techniques that are widely used in schools, called 'brain gym', which I myself have been subjected to and wasn't overly enamoured by. These techniques include things such as creating 'brain buttons' which can be used to stimulate your carotid arteries from outside your ribcage by simply rubbing your chest. Obviously impossible. He then goes on to discuss the fact that the cosmetics industry are using long words which the general public are unlikely to understand in order to sell more products on the basis that if people do not understand the sciencey words they are likely to think that the product will be beneficial to their health. For example, the use of the names of specific compounds that are ingredients in the cream, when in fact, if you look closely enough at the packaging, or any of the advertising for the product, there are no claims that those specific chemicals will actually make you look better. As the author states, the claim is made for the cream on the whole, because as we are all aware, moisturising the skin will make it look nicer, but that could be done using a cheap cream as opposed to the expensive one with the magic, fancy chemical. This is an interesting point, which basically encompasses the message Ben Goldacre is trying to get across for the rest of the book, and that is the fact that we are too quick to believe the things we are told, particularly when it comes to scientific fact.
A fantastic example of this is the famous case with the MMR vaccines being linked to autism. The case which was eventually disproven, but only after thousands of children didn't receive the safe vaccination they needed to protect them from extremely dangerous diseases. This book addresses the idea that we are so easily misled in a clever and humorous way that keeps the reader engaged in even the most potentially tedious areas of deeply confusing statistical methods.
One thing I'm really glad I've been able to take from this book was knowledge of the Cochrane Collaboration, an organisation who carry out reviews of clinical trials and review them systematically, which has provided us with a database of information about how well the trials were conducted and the results found over a collection of trials as opposed to just one.
Overall, I loved reading Bad Science and feel that it educated me on the pharmaceutical industry as well as opening my eyes to some of the money making scams and how the media mislead us on scientific topics every day. I would definitely recommend it.

How much of our brain do we actually need?

I attended a gifted and talented conference a few months ago where we were told about a man who had walked into a hospital with enlarged ventricles meaning that his actual brain tissue was reduced massively. I was so fascinated by this because I could not get my head around the fact that the brain can be so significantly damaged and for someone to be able to function with almost no real problems. I read further into this and found that this man had an IQ of 75, which is of course below average but by no means unusual, and definitely does not indicate the level of damage to his brain tissue which was seen. To me this shows just how much our brains can adapt to certain circumstances. This is especially impressive considering that the man had suffered from hydrocephalus as a child, which can often kill. The man must have had immensely increased intracranial pressure which, in his severe case should have caused some sort of mental disability. 

Another interesting case of brain injury (that I read about in Impulse) was the case of Phineus Gage, who had a metal rod driven through his brain, but managed to survive reasonably unchanged, given the circumstances. This is due to the fact that the rod penetrated his left frontal lobe, the area of the brain associated with recognising consequences and knowing the difference between right and wrong (among other things of course), which would explain why Gage's injury only resulted in a change in his voluntary behaviour. This was, of course, famously recognised by his peers, and the reason he was fired from his job as a foreman. 

I find it incredibly interesting that the brain is such a complex and vital organ, but can take serious damage without fatal consequences. When even the smallest thing goes wrong, for example in 'silent strokes', it can have significant effects, such as the onset of vascular dementia, but others can have a huge steel rod pushed through and remain mentally competent. It is definitely fair to say that the human body is a well oiled machine and something I often wonder if I will ever truly get my head around. 

Paediatric A&E

A&E has always been an area of medicine I have wanted to look into purely because it always seems so exciting and diverse. One of the reasons I love the idea of becoming a doctor is that I know I will never be bored and A&E has always appealed to me because of the need for quick and efficient problem solving and the ability to work under pressure. Some people might view this as scary or unpleasant but I love situations like that. So, when I was offered some time with a consultant in paediatric A&E at my local hospital, I jumped at the opportunity. I arrived and was sent straight to the staff room area which was full of doctors at computers typing away, with a big TV screen on the wall with names and DOBs and injuries on. I was introduced to a few doctors and told to just shadow anyone I liked. Great.

As soon as someone picked up a card to leave the room, I jumped up too and followed. A finger injury on a young boy following an incident with a folding chair… Oh dear! It was definitely difficult seeing the child so upset but it was nice to watch the way the doctor interacted with both the child and the parent. Reassurance, support and professionalism with the parent, and care, patience and compassion with the young child. 

After seeing the patient, I followed the doc to go and fill out a multitude of online forms to allow the boy to be discharged. That area of medicine is something which is definitely not well known among wannabe doctors, but it didn't bother me too much. I saw it as a pleasant break from patient contact to consolidate the things I'd seen and reset myself to go back to see more patients. 

I saw lots of chest infections but one which stands out was a young boy who was covered in a rash. I went into this consultation with a medical student who was doing a placement and after taking the history and conducting the physical examination, she suspected scarlet fever, but was unsure, and so didn't mention anything to anyone before relaying her findings to the consultant. By doing so, she avoided panic and ensured that no unnecessary concern was caused. The consultant then went to do her own exam and ruled this possibility out and diagnosed a chest infection. However, the medical student was still applauded for her efforts, despite her initial diagnosis being incorrect, because she was able to seek help and reassurance. This highlighted another, less obvious quality of a good doctor, and that is being able to check your work and recognise areas of weakness, asking for help where necessary, especially when the welfare of others is in question. 

Because I quickly got on really well with the medical student, she taught me how to take patient histories and taught me a method she had recently learnt called BINDS used when taking the histories of young children. B stands for birth, as in was the birth normal? Natural or Csection? I- Immunisations, are they up to date? N- nutrition, are they eating normally, enough, still have an appetite, drinking enough, less/more than usual? D- development, are they developing the way you would expect, do they act in similar ways to other children their age? S- social background, who do they live with? Do they live with any pets? 

Overall, I loved A&E experience :) 

Genetic Modification

This topic seemed to be a recurring theme in this month's New Scientists, and it got my attention. My first main interest was in a study being conducted by Oxitec, who were using GM mosquitos to fight the spread of dengue fever. The mosquitos were modified to die before reaching adulthood. A group of male GM mosquitos would be released into an affected area and then mate with normal (infected) females. Their offspring would die being reaching adulthood and the spread of the disease would be cut. Primary test in the Jacobina region of Brazil show that the number of eggs fell by up to 92% but there was no fall in the incidence of dengue fever. This, however, could be due to an extremely small sample size. The article states that a full epidemiological study must be conducted before results can be seriously considered. This concept is really topical in the world of medicine, with diseases like malaria causing so many deaths every year. If this study proves successful, could we be looking at seriously fighting malaria?
The second incidence of modification was in worms. Scientists had conducted a study involving the neurons of nematodes. They started by using electrical synapses to bridge a gap junction involved in recognition of salt concentration. They did this by injecting DNA onto the gonads of Caenorhabditis elegans which codes for a protein involved in establishing extra neural connections. They used mouse genes to avoid interaction with other neurons and found that the response to salt in the next generation of worms was massively depleted. The second investigation they conducted was in the smell of these worms. They added electrical synapses to neurons previously connected by a chemical link. This retraced the signals and eliminated the worms ability to recognise smells. This circuit for smell in the worms is comparable to circuits for eyesight in other organisms, which poses questions as to how else this technique could be used. One suggestion from the article was that it could be used to treat stroke victims. They could be given a pill to reconnect the damaged areas of their brain by creating neural bypasses to avoid damaged areas. Another important idea raised was that, by editing synaptic pathways, one could genetically modify an organism to possess a specifically grown brain circuit with a certain skill set. This could include organisms such as worms able to protect crops by identifying dangerous bacteria, which is definitely appropriate given the food crisis we are heading into. However, this made me wonder whether the genetic modification of organisms is ethical. Admittedly, in nematodes, it is less of a concern, particularly given their small CNS, but in larger organisms, it raises an issue for me. If we are able to insert skills be rewiring a brain in a certain way, why do we need to learn? What need to we have for education? When we are simply able to have an operation to allow us to have a certain skill set, why would anyone want to spent 4 years and a crazy amount of money to train in that skill? When society is levelled out in this way, it reduces the need for skilled individuals. I think this is a dangerous concept.
And I believe lots of the rest of the population agree with me that GM can be a little scary, perhaps just for different reasons. Another article was discussing GM crops, and it was heavily focused on the public opinion of this idea, which is generally fairly negative. They seem to be concerned about the ideas of 'tomatoes with scorpion genes in them,' and this concern seems to make them reluctant to consider the less shaky, more high tech ways of modification. They also appear to be unaware of how regularly genes are naturally swapped between species in the wild. This got me thinking why people have this view. Is it the fault of the scientific community? Or is it simply that they haven't bothered to do enough research into it themselves to see that there are alternatives that don't involve putting a salmon genes into strawberries? Either way, the scientific community is forced to concern itself with this public opinion, and I can't decide if this is right. I'm not sure that it seems right that professionals are forced to halt all progressions in their research if someone unqualified doesn't really like it much, particularly if the research is looking into solving a world issue, such as the food crisis. Granted, if the public are unhappy about GM crops, the research may be slightly useless because they won't buy the product, but can this concept be transferred to other areas? For example, stem cell research. To be answered.

Work Experience

Having already done some work experience in France and finding out how exciting it can be, it's fair to say when I was able to organise some more in England with an NHS doctor I was absolutely chuffed. I'd really struggled to find any work experience in the NHS because of my seriously busy schedule, particularly around exam season, but I finally managed to organise some with a doctor, called Sam, who had a clinic for looked after children. I spent a day with her in her clinic and was able to watch the complex interactions in a highly sensitive situation. This was unlike any other exposure I had had to medicine before and I enjoyed discussing the way these situations were handled with Sam, including how she handled the emotionally challenging cases she saw daily. Something that I found particularly difficult was the often detached and impersonal way the fosterers could talk about the children they were caring for. I found it difficult to see carers discussing 'problems' they were having with the children they were looking after while they were in the room. Often the carer would talk about the child in a very negative way, despite the fact that they were present at the time. I brought this up with Sam after one particularly difficult consultation, telling her how I found it sad that the young boy had to sit and listen to the carer basically complain about him. She explained to me that often the view of an outsider on these types of situations can be that they are harsh and upsetting but that through training and exposure, she reassured me that these things become easier and that finding it difficult was simply a sign of remaining compassionate, as opposed to be unsuited to a medical career.
Another part of this experience I found interesting was discussing ADHD, as it is diagnosed more often in looked after children than average. I learnt that this is because looked after children are often victims of trauma, which can cause similar symptoms meaning that they are misdiagnosed as having ADHD, when in fact they are simply responding to their hyper vigilance, as opposed to hyperactivity. When I got home, I looked into this more, and found an article which described that children who experienced trauma, such as violence, are much more sensitive to subtle changes in tone of voice, facial expression or body language due to a fight or flight mentality they have been forced to adopt. This explains why often at school, they can seem easily distracted by irrelevant concepts, such as sounds around them or the behaviour of other children. This can cause concentration on normal subjects to be hugely difficult for the children, and can be easily misdiagnosed as ADHD. The article (http://healthyliving.msn.com/diseases/adhd/diagnosis-adhd—or-is-it-trauma-1?pageart=2) states that often the drugs prescribed for ADHD can act as a stimulant, which of course would make the symptoms worse. This, to me, highlights how important it is to ensure the correct diagnosis is made, especially given that fostering, adoption and placement are all considered to be potentially traumatising.
Sam also allowed me to attend a genetics lecture organised by the department. Despite struggling to keep up with some of the more complex ideas, (especially those involving lots of acronyms that I had never heard of!) one thing I took out of the talk was an interest in Huntington's disease. This was brought up because it causes an ethical difficulty when screening looked after children whose grandparents have showed symptoms. If the parents do not wished to be screened or would rather not know if they have the mutation related with HD, it becomes difficult to screen the children, because of course if they are positive, it's obvious that one of the parents is also positive (because it is autosomal dominant mutation and does not skip generations). This is a problem because if a grandparent has symptoms or has been confirmed as having HD, there is a chance the child will also have it, and one could argue that the child deserves the right to be screened, particularly in cases where the gene is suspected to be from the father. This is due to greater instability in the paternal genes than maternal genes, meaning the mutation could be greater and therefore could lead to early onset Huntington's.

Impulse by Dr David Lewis

I recently read Impulse and thoroughly enjoyed it. Upon primary examination, while trying to choose a book to hand in for my school’s speech day as a prize, I was interested by the concept of the book; looking at why we do things without knowing why we do them. At first, it seemed as though it was mostly based on general psychology and so I did not expect to read much hardcore medicine related science, but was still interested nevertheless. I was pleasantly surprised to find that in fact the book was heavily science based and had plenty for me to get my teeth stuck into!

I read it while away on a trekking and volunteering expedition in the Atlas mountains in Morocco with a group, and managed to get them all interested in certain aspects of the book, such as how the length of index finger in comparison to ring finger can be used to find a ratio which is then used to determine the likelihood of the individual partaking in risky behaviour.

Another aspect of the book that I found particularly interesting was the section that discussed how animals can use a subconscious sense of smell to avoid inbreeding within their species. This caused me to do some further reading and I found that this occurs largely in birds, such as penguins. This also helps them to find their mates after a long period of foraging, and allows them to find their habitats after days at sea. The same principle applies with mice. They use the their sense of smell to detect which other mice are closely related to them, due to the genes relating to smell being on the same part of the genome as the genes related to the way the immune system identifies its cells. This produces the concept that if you smell similar, you are likely to be closely related. An experiment was done claiming that mice avoid inbreeding in this way, where a mouse was placed into a cage with its brother. When forced and with no other option, the mice would breed. However, if another, non-related male was introduced, the female would mate with the other male over the brother. Interestingly, if the second male was introduced after the female had fallen pregnant, the female would abort her current pregnancy to mate with the new male; a good mechanism to avoid inbreeding. Dr David Lewis claimed that this concept could be transferred and was proven to be in use among humans, in that we subconsciously find people with similar smells to our own less attractive, which is nature’s of way of preventing incest, using MHC (major histocompatibility complex) genes.

The overall message of the book is that a lot of what we do, or at least think we do, consciously, is in fact down to our genes or factors that we cannot control. This introduces the idea that ‘free will in an illusion.’ This is a dangerous concept, as highlighted in the final chapter of the book, due to the fact that it removes all personal responsibility and makes punishment of criminals significantly more difficult, particularly if it were to be widely recognised that free will is in fact a grand illusion. We would no longer be able to send murderers or psychopaths to prison because they could quite easily blame their subconscious (system I) brain and claim they were not in control of themselves; a dangerous and scary concept in my opinion.