I was at Brighton Medical School recently, talking ethics to third years, and a lively and engaging bunch they were too. Among the many things we talked about were electives, particularly in resource poor countries. It is no surprise that students look forward to their electives. The travel appeals of course; the ability also to escape the tourist rat-runs, tourists having a terrible tendency to denature the places they tour. I certainly know from experience that there is nothing like a visit to a psychiatric hospital in sub-Saharan Africa to remind you that there is more to the world than you will find between the covers of a Lonely Planet guide. There will almost certainly be interesting clinical opportunities: the chance to see creative responses to extreme resource shortages. Depending on the location there will be conditions that you are unlikely to see at home. There may also be opportunities to learn from non-traditional carers. I have also heard it said they can be a good opportunity to take on more clinical responsibility than students are ordinarily given in the UK. And this is where things can get troubling. It was students who first alerted me to the problem. A few years ago, on returning from their elective, a group of students wrote to the BMJ describing the behaviour of a student colleague. Released from oversight he saw an opportunity effectively to practise on a captive population. He altered a prescription written by a local doctor; he photographed patients undergoing intimate procedures without consent, and he performed an unnecessary lumbar puncture because he fancied “having a go.” You would need to be deaf to history not to hear unsavoury echoes of colonialism in his behaviour: a western medical student practising techniques well beyond his competence on patients who thought him a western doctor. As the students wrote: “The local healthcare professionals sometimes perceived white skin to be synonymous with expertise, placing unprecedented levels of trust in us and allowing us to make decisions and perform procedures that would be unacceptable in the United Kingdom.” An extreme case no doubt but it points to a necessary moral: medical students are not qualified doctors and they have no greater licence abroad than at home. It should also be said that these students did precisely the right thing: when they saw unethical behaviour they confronted it and they spoke out. And not just locally. Writing to the BMJ on their return ensured the problem was given wider exposure. more…

My fellow FY1s and I have been flying solo for over three months now. It has been filled with “firsts.” First day of work, first night shift… first pay cheque. All exciting milestones in their own right, and each followed, perhaps naïvely, by a sense of achievement having surmounted such momentous obstacles. Time has sprinted by, as demonstrated by my radio silence on the BMJ blogs front. What little spare time I have seems to be spent on my new favourite pastimes: eating and sleeping. However at time of writing I have foregone these two pleasures as I find myself in an almost heavenly lull during my night shift. more…

In the nineteenth century there were few standards in medical education. Students would often do an apprenticeship with a general practitioner and gradually gain experience in the trade. They had to pay for their education—which barred all but those from the privileged classes from becoming a doctor. For those who did persevere with their education there was the constant thought—am I getting value for money for my fees? more…

I’m glad I learnt anatomy via the declining art of full body dissection. I’ll be dining out on the stories for years. It’s one of the first things that people ask about when they learn I’m a medical student, and they aren’t satisfied until they’ve heard details: the smell, the cadaver’s pallor, the grisly chill of the dissection room. To me, this fascination indicates a popular obsession with medicine’s uncomfortable position somewhere between the heroic and the macabre. Doctors are portrayed as upstanding, life-saving, laudable; but also as grisly and mysterious. They alone are allowed to slice open humans, terminate foetuses, break societal taboos. more…

My mother is widely regarded in many circles as something of a medical expert. What she lacks in actual knowledge is made up for by unbridled confidence. For one thing, she proudly gabbles the names of drugs and diseases after the first syllable so conversations quickly degenerate into a medical guessing game. She was also very concerned for my wellbeing during my psychiatry rotation, due to a misplaced fear of the contagiousness of mental illness. I will be the second doctor in my family, but the first to have gone through medical school. more…

In my opinion a recent Panorama programme, “Britain’s Secret Health Tourists,” didn’t do justice to a complex issue. With a Department of Health consultation looming on the issue, it’s important doctors understand why. I’ve attempted to summarise the evidence on this issue elsewhere, so here I’ll stick to the key points that I think Panorama got wrong, conflated, or forgot to mention.

The key scoop presented by the Panorama team was that middle men were, for a fee, arranging GP registrations for foreign nationals. The problems with presenting this as a scoop are, firstly, that GPs are entitled to register whoever they wish so long as they don’t discriminate and, secondly, that the exploitation of vulnerable migrants is sadly not news. more…

“Even in comparatively poor countries we find scientific knowledge and trained intellects regarded as sound public investments, and the popular voice applauding a liberal application of public money to secure them.”

Isambard Owen, 1904 more…

In the summer of 2010, fresh from my 3rd year of medical school, myself and another student chose to take a six week elective in Bhopal, India. Our motivation to choose the capital of India’s most central state? An opportunity to learn first hand about an ongoing industrial disaster—the biggest in history.

This came about after meeting a UK investigative journalist who was the first to cover the story in the UK. Following this, we were put in touch with a Brighton based charity that funds a primary healthcare centre, which provides free medical care for gas victims. The scale of the problem, in a city with a population of almost two million, shook us to the core and left us determined to try and highlight this issue in someway. more…

I am currently on my psychiatry rotation. Psychiatry is one of those peculiar specialties that tends to polarise medical students. Some dismiss it as merely asking, “And how does that make you feel?”, while others are like my housemate, whose eyes light up at the mention of psychosis and neurosis. Myself, I am approaching the specialty with an open and insatiably curious mind.

One thing I have noticed is that psychiatry throws up the sort of questions that endocrinology, say, just doesn’t. more…

At the start of London’s Paralympic Games, ITV’s Don’t Hate Us, broadcast on Thursday 23 August, is a stark reminder of the levels of hate crime against the disabled in this country. The programme explores a shocking statistic: of the 65,000 estimated hate crimes against the disabled last year, only 2,000 were reported and only 500 resulted in a conviction. 66% of those with disabilities questioned in a recent survey said that they had experienced aggression, hostility, and verbal abuse, and 47% said that attitudes had worsened in the last year. Presented by Francesca Martinez, an actress and comedienne with cerebral palsy, Don’t Hate Us highlights a number of horrific cases of hate crime in recent years and discusses the root causes of this hatred. more…