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Impact of COVID-19 on experiences of BAME doctors and future steps:

Fri, 06 May 2022 13:05:02 GMT

Silence in the presence of oppression is a gateway to complicity.

It is not an unknown fact that we have an unequal NHS. However, what is often denied, is the fact that this unequal culture significantly disadvantages BAME health care professionals.(1). COVID-19 has disproportionately impacted BAME communities via a combination of racial, discriminatory, and socioeconomic inequalities (2)

It is perhaps not a surprise that the impact of the crisis has significantly affected those already facing discrimination. These double jeopardy scenarios are not uncommon. Throughout the pandemic BAME doctors have reported that they felt additional pressures and that they were put at a greater risk due to inadequate PPE and were deployed to work frontline on the COVID wards within the workplace (3,4). In April 2020 the BMA called for an inquiry into the impacts on the BAME communities as they were found to be at higher risk of acquiring the infection (5).

A survey of health care workers undertaken by Mr Aftab on their views of racism within the workplace highlighted the continuing lack of risk assessments and protection for BAME health care professionals (6). It also demonstrated the prevalence of both outward racial attacks as well as microaggressions. Microaggressions are defined as “common and daily verbal/ behavioural indignities that communicate hostile or derogatory racial insults towards people of colour” (7). They often stem from unconscious and implicit bias and are not intended to be offensive (8). The unintended consequences make it difficult to fully comprehend the impacts; this does not negate its importance. Accordingly, institutions need to be deliberate and inclusive and acknowledge that racism, not race, is the driver of health inequalities (2).

The extent to which an organisation values its minority staff is a good barometer of how well patients are likely to feel cared for (2). Having a motivated, involved, and valued workforce benefits patient safety and provides high quality patient care with increased patient satisfaction.

The Workforce Race Quality Standard (WRES) was implemented in 2016, and functions to break down structural barriers regarding race equality9. Going forwards, equality, diversity and inclusion measures could be used as key performance indicators and should be core to appraisal.

What can be done?

There is a need to move beyond rhetoric and token gestures and address the structural root causes. It is not enough to just “not be racist”. Rather, it is imperative that we move towards anti-racist environments. Participation is required at all levels of decision making, with economic support and explicit goals put in place2. Those in positions of power need to be allies and take accountability. Real change requires radical and transformational actions.

Open and perhaps uncomfortable discussions surrounding racism and its impacts on health disparities are essential social movement approaches (8). These are needed to motivate change and make commitments to inspire progress. The persistence of racial inequalities could in part be accredited to the lack of political will in addressing the subconscious bias. Nevertheless, all medical professionals need to take an active role to challenge inequalities (10).

Negative perceptions and stigma often based on historical injustice need to be challenged. A key issue in this pandemic is tackling vaccine hesitancy. This requires BAME doctors’ active involvement to reduce suspicion from BAME communities towards authorities. There are perceptions that inappropriate behaviours by these communities could be increasing their risk of contracting the virus in the first place. Research studies should explore evidence to substantiate or refute that (11,12).

The professional identity of a doctor is not just clinical but psychosocial- this extends to colleagues as well as patients. Frontline clinicians and the wider community need to unite around a shared purpose- vanquishing the blight of inequality within our healthcare systems.

Acknowledgement and References:

Many thanks to Dr Mohamed Sakel for inviting me to attend the cross-specialty research team live event (5th March 2021) on “Evolving trends in vulnerabilities and impact during COVID-19”.

Nagpaul, D. (CBE). Experiences of BAME doctors in NHS prior to and during the pandemic. Presentation presented at; 2021; Webex.
Rao, M (OBE). Evolving knowledge of vulnerabilities and unequal impacts during COVID-19. Presentation presented at; 2021; Webex.
Cooper K. BAME doctors hit worse by lack of PPE [Internet]. The British Medical Association is the trade union and professional body for doctors in the UK. 2021 [cited 6 March 2021]. Available from: https://www.bma.org.uk/news-and-opinion/bame-doctors-hit-worse-by-lack-of-pp e
Rimmer A. Covid-19: Disproportionate impact on ethnic minority healthcare workers will be explored by government. BMJ [Internet]. 2020 [cited 5 March 2021];369:m1562. Available from: https://www.bmj.com/content/369/bmj.m1562.short
COVID-19: the risk to BAME doctors [Internet]. The British Medical Association. 2021 [cited 5 March 2021]. Available from:
https://www.bma.org.uk/advice-and-support/covid-19/your-health/covid-19-the-risk-to-bame-docto rs
Aftab,S. Survey of health care workers about risk assessment, PPE + perception and views about racism at their place of work. Presentation presented at; 2021; Webex.
Sue DW, Capodilupo CM, Torino GC, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–289 https://doi.org/10.1037/0003-066x.62.4.27
Acholonu R, Cook T, Roswell R, Greene R. Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL [Internet]. 2020 [cited 5 March 2021];16(1):10969. Available from: https://www.mededportal.org/doi/full/10.15766/mep_2374-8265.10969?utm_campaign=mededportal&utm_medium=email&utm_content=newsletter&utm_source=sfmc
England N. NHS England » NHS Workforce Race Equality Standard [Internet]. England.nhs.uk. 2021 [cited 5 March 2021]. Available from: https://www.england.nhs.uk/about/equality/equality-hub/equality-standard s
Hockey D, Omar S, Gavin M, Power R. Health inequalities: what can health care professionals do?. Presentation presented at; 2020; Zoom.
Hossain MA, Jahid MIK, Hossain KMA, Walton LM, Uddin Z, Haque MO, Kabir MF, Arafat SMY, Sakel M, Faruqui R, Hossain Z. Knowledge, attitudes, and fear of COVID-19 during the Rapid Rise Period in Bangladesh. PLoS One. 2020 Sep 24;15(9):e0239646. doi: 10.1371/journal.pone.0239646. PMID: 32970769; PMCID: PMC7514023.
Knowledge, Attitudes and Behaviours towards COVID-19 amongst Kent BAME residents during the UK COVID-19 pandemic, a qualitative study. University of Kent. Principal Investigator: Dr Mohamed Sakel

In Conversation with: Dr Patrice Baptiste

Thu, 07 Jan 2021 17:55:11 GMT

1) Introduction: About yourself and the career speciality you are in now?

I am a portfolio GP, medical educator, entrepreneur, writer, author, visionary and champion for diversity within the medical profession.

As a portfolio GP, I spend the majority of my time in clinical practice with the remainder of her time divided between a number of other careers and interests.

As a medical school examiner at Queen Mary University London I examine students during their practical or Objective Structured Clinical Examinations (OSCEs). I also works for the General Medical Council (GMC) examining doctors who have qualified abroad and wish to practice in the UK through my role as a PLAB (Professional and Linguistic Assessments Board) examiner.

Through my company, DreamSmartTutors, which launched during 2016, ( www.dreamsmarttutors.co.uk ) I support prospective medical students on their medical journeys whilst simultaneously aiming to increase diversity within the medical profession. As a STEM ambassador, I also aim to encourage school students to pursue Science, Technology, Engineering and Mathematics (STEM) subjects.

I am also a keynote speaker, having delivered a number of talks at places such as Oxford university, The British Medical Journal (BMJ) Live Careers fair and The Royal College of Physicians Edinburgh. As a freelance writer I have written for the British Medical Association (BMA), the BMJ, the Medical Protection Society (MPS) and the Support for Doctors Network to name but a few.

I regularly contribute to GP online ( www.gponline.com ) discussing important topics pertaining to General Practice and have published a short guide for those looking to understand a medical career in addition to this first of four poetry books. These can be found in the 'Publications' section on her profile below.

2) What is the most rewarding/most challenging aspect of your job?

I enjoy being able to establish and maintain a long term doctor patient relationship with my patients. This is very difficult to do when working in the hospital. I am also able to follow patients up and provide continuity of care. This enables me to provide a high standard of care for my patients.

3) What can medical students/ aspiring students do now to get to where you are now?

Everyone has a different path and therefore my advice would be to get to know yourself, your personality, what you enjoy and don't enjoy. This will enable you to create a unique career path that you are happy with.

4) What advice would you give your younger self ?

Don't worry so much. Often the things I worried about during my journey to becoming a doctor were so unimportant looking back and I can barely remember what the worries were about! If you find you are a worrier then ask yourself, whatever you are worrying about in the grand scheme of things does it really matter and will it matter/will you remember it in 5-10 years? If the answer is no, then try not to worry so much!

5) What inspires and motivates you to do the work you do?

I have always been an ambitious and highly motivated person. I enjoy learning new things and developing as a person.

Maintaining faith in medicine

Mon, 07 Dec 2020 12:13:38 GMT

In a world where there are prevalent medical ethics, such as recently stances on physician-assisted dying, views on abortions, gender and much more, I believe that maintaining faith has been so important to face these challenges and approach them with Godly wisdom. Faith for me has also been my first comfort in the stresses of medicine - the huge workload, the long working hours, the emotional labour. Making faith a priority can definitely be a challenge and my aim is to share some principles that I have found useful in managing this!

PRAYER:

Not one day in medicine will ever be exactly the same - we will always encounter new people, new patients and face new opportunities as well as dilemmas. As a Christian, I think it is essential to put aside time everyday to pray for these. But with so little time to have a break, how is that achievable?

“And pray in the Spirit on all occasions with all kinds of prayers and requests. With this in mind, be alert and always keep on praying for all the Lord’s people” - Ephesians 6:18

In this verse, I’ve highlighted all kinds, because it is easy to forget there are so many different ways to pray - there is individual/ group prayer but also different locations in which you can pray. One form I have recently incorporated more into my life is prayer walks because with medicine, particularly when I am walking to lectures, or travelling from GP home visits at placement, I have found that I have the most free time when I am actually on transit between places. Also consider if you are a morning or evening person, being an early bird myself I love to get up early and just start my day just being thankful to God. It can be so easy to focus and become frustrated in afflictions that we face, that we forget to rejoice the great things that God has placed in our lives:

REST:

I’ve already touched on how fast-paced medicine actually is and it is so important to self-care for ourselves that we avoid feeling overwhelmed 24/7. So what does rest have to do with having faith? Well often when we are feeling tired and exhausted, we want to be alone in peace and quiet.

“But Jesus often withdrew to lonely places and prayed” - Luke 5: 16

Note even Jesus rested in silence & solitude too and I think that it’s important that we try to incorporate this practice into our daily lives. How can we do this?

Switch off your phone/ notifications! When was the last time you’ve done so? Embrace the comfort of yourself and God’s company in pure silence - perhaps try this a few minutes a day and reflect/ meditate! If you are not comfortable with silence, how about some gentle worship music in the background?

Do something relaxing that isn’t medicine! For me, I love playing violin and being part of ensembles, baking and just lazing with housemates watching Netflix. Find something that fits in with your schedule and commit to it weekly at very minimum to put out time for yourself.

Sabbath - I have to admit this 6 days a week principle I struggle with - a whole day of nothing related to Medicine is something that I am working on, but let us not forget God rested on the seventh day!

COMMUNITY:

Finally, having a great support system in your faith is so important that you are always encouraging one another. As a medical student, I find that support in my church family, particularly my small group, but also by being part of Christian Union and Christian Medical Fellowship. CMF has been great in supporting me with tackling medical ethics and how to share faith confidently and correctly in my career. I highly encourage you to check out their resources

https://www.cmf.org.uk/resources/publications/cmf-files/

) and see if there is a student CMF in your area to be a part of. If you are a doctor or other health professional, your schedule may mean that you cannot always attend church or be part of teams; but endeavour to at least have an accountability partner/mentor who you can call to help to confide in and help you to grow spiritually.

----------------------------------------------------------------------------------------------------------------

You may not be a person of faith, but I would still love for you to take time out for yourself and surround yourself with good people. If you are, I hope that this has inspired you to keep on working on your faith; regardless of what religion you identify as, you don’t need to choose between faith and a career - faith should be intertwined in everything you do, say and choose. I pray that you will maintain it in your medical journey!

Still we rise.

Sun, 25 Oct 2020 19:06:25 GMT

Growing up black comes with so much hardship, however, when faced with adversity, we are still able to rise and accomplish extraordinary things. With the resurgence of the BLM campaign alongside the protests happening in Africa, Black History Month is especially important this year, despite it being difficult to celebrate our success whilst enduring hardship. Africa is such a powerful continent with rich culture and resources and has so much to offer, but neo-colonialism and poor leadership have prevented it from its potential. In Nigeria, there are END SARS protests against brutality and oppression by the police. SARS Special Anti-Robbery Squad was created in the early ’90s to protect its people, yet over the years instead of protecting its citizens they have abused their position of power and murdered and tortured their people instead. People deserve to be able to live in peace and not live in constant fear. In Namibia, there are protests against sexual and gender-based violence and there's currently a holocaust going on in Congo. Ghana and the Ivory coast children are being trafficked, in Cameroon, there is the anglophone crisis and in South Africa, there is a rise in femicide. During the Black Lives Matter movement earlier on this year, we stood as one and our voices were being heard. We need to continue to use our voices and spread awareness for there to be change because all black matters matter everywhere.

These are devastating times and it can be so heart-breaking and overwhelming especially having to face it daily, the weight of this can be unbearable but it needs to be acknowledged. We cannot live fulfilling lives without overcoming the hurt and the anger.

Adversity as a black woman is nothing new; our hair, character and sexuality are constantly scrutinised but when it comes to our safety and the way we are treated people are not concerned in the slightest. This is deeply rooted in racism which is so covert nowadays we tend to ignore it and continue to carry the burden, but as Malcolm X said ‘The most disrespected person in America is the black woman. The most unprotected person in America is the black woman. The most neglected person in America is the black woman.’ Our pain and struggles continue to be overlooked and this is very much evident with the death of Breonna Taylor. Emphasising once again that every aspect of society is a reminder that racism and discrimination is very much alive, and it is going to take a collective effort to rid ourselves of centuries of hatred and prejudice. Her murder along with the countless innocent lives ruthlessly killed has once again shown us that black lives and especially black women are disposable, and we are invaluable and the very people that were put in place to protect her, are the ones who caused the most harm. Even in Nigeria the government, most importantly President Buhari has a duty to its people and to do right by them but rather than obliging the basic cry for help from the youth of their country they are governed by greed and corruption.

Black Pound Day (BPD) founded by Swiss; a member of So Solid Crew, started for the first time at the end of June and allows us to celebrate black-owned businesses and help circulate more money within our own economy, which in turn helps us to give back to our community. Maya Angelou said, ‘You may shoot me with your words, you may cut me with your eyes, you may kill me with your hatefulness, but still, like air, I’ll rise.’ BPD helps showcase smaller businesses and gives us a way of celebrating our culture and success.

GUAP media company has shown a new and innovative approach of displaying and promoting diverse individuals within the creative industry. Their magazine the Renaissance issue this year featured a prominent figure in the UK creative industry Nella Rose on the cover, which captured not only her beauty and showcased her talent and culture but highlighted the importance and influence she has within the community and despite the injustices we face we are still able to flourish.

Sharon Chuter of Uoma Cosmetics came out with a Pull Up for Change initiative, which helps give economic opportunities to black people. The aim of her campaign is to hold brands and companies more accountable. It asks the ones who came out in support of the Black Lives Matter movement to release the number of black employees in the organisation especially in executive and senior roles. Many companies showed solidarity and support publicly, but it is important to see what companies are doing behind closed doors and what they are going to do to improve.

This month is all about highlighting our success and educating ourselves and others as well as learning from these experiences. We still must be able to celebrate ourselves as a community and be able to uplift ourselves whilst recognising our struggles. We can celebrate ourselves by not being ashamed of our culture and truly embrace it particularly when it comes to food, clothes and our hair and normalising sharing our culture to our friends of different ethnicities.

By Toyosi Omotoso

University of Ostrava

Why is Black History Month important?

Thu, 15 Oct 2020 16:59:32 GMT

“Why do we still need Black History Month (BHM)?”

“It disregards other POC communities”

“It’s way better than it used to be”

“We don’t have a White History Month!”

Sound familiar? Perhaps there is an element of truth to these statements. A truth that believes that things are actually getting better, that the black struggle isn’t “as bad” anymore or that we are creating our own division by only showcasing our success and not everybody else’s. But who is this rhetoric true for? As a young black woman, I take pride in celebrating BHM. I believe the foundations of our past must be brought to light, to not only black people but the world. The unfortunate reality is that we live in a world where those that have suffered at the hands of societal norms are not seen the same as their counterparts.

Think about it.

We don’t have to fight for the rights of white, straight able-bodied men because in all these categories (race, sex, disability and gender) they reign superior over anyone or anything that poses different to this image. And historically, anyone different has suffered oppression – to the point that the repercussions are still being felt in our everyday lives. For several reasons, I feel that this month is essential for the black community, to continue to re-establish [not only ourselves] but the history that was once erased from us.

1. BHM is a cause for celebration

A frequent saying this year is that we are fighting two pandemics: COVID-19 and racism. The sudden surge of support for the Black Lives Matter (BLM) Movement this summer was a moving but exhausting period of time. With justice being finally acknowledged in some instances, it was very draining to get people to realise and understand that black lives are as equal and worth fighting for.

BHM should be honoured in all its glory as it enables us to change the narrative.

We can uplift, celebrate and strengthen individuals who are aiding to advance our community as a whole, and remember those who made it their life's purpose to better our future. From the Civil Rights Movement in the 50s/60s to Joshua Beckford, the youngest boy to attend the University of Oxford, there is so much success worthy of recognition amongst us. Yes, it has been tiring especially with the deaths, inequality and oppression we have witnessed. However, Black History Month allows us to focus on the good and be hopeful for the change to come.

2. BHM is an education tool

There is power in learning about your history. To have a complete understanding of your identity and how rich your culture is. In many 1st world countries, where our parents or grandparents have migrated to, it is very easy to adapt to the country’s customs and adopt their history as our own. To an extent, we do identify with such e.g. being Black British. But on the other hand, a lot of us are unaware of the role our ancestors played in building the foundations of western countries or the contributions they made to creating an equal playing ground for us. Everybody knows the names of the 6 wives of Henry VIII, but have you heard of the Bristol Bus Boycott of 1963? Inspired by the Montgomery Bus Boycott in the US 10 years prior, Paul Stephenson and the West Indian Development Council led the boycott of the Bristol Omnibus Company, as racial discrimination was rife in their employment sector. Lasting four months, the company eventually overturned their refusal to employ Black and Asian staff. BHM gives us the chance to seek and delve into our rich past, a past that we’re perhaps less likely to acknowledge in the diaspora.

Personally, I feel that this month is also educating people outside the black community. The responsibility isn’t necessarily on us to teach others about their own privilege or the systems put in place to oppress us. However, the promotion of BHM is impossible to ignore – in arts & culture, TV & radio, politics, businesses, education (and more); there are many avenues to learn about our cultures/history and why the month as a whole is celebrated.

3. BHM acts as a reminder

Although a significant change has been made, there is definitely a long way to go. Oppression still occurs today, but it just “looks different”. In some cases, racism is not as overt as it used to be, but it is still in operation. I believe this month acts as a reminder to all of us that the work to dismantle systemic racism, to get black history taught in schools, to change stereotypes associated with us and so on is an ongoing fight beyond the month of October.

Why? Because:

- Last year 24% of black people were shot in the US, when they make up only 13% of the population

- In a study at the University of Virginia in 2016, white medical students were more likely to show racial bias when administering pain treatment to patients

- Ofcom received 24,500 complaints about Diversity’s BLM performance on Britain’s Got Talent

- Black women are 3 – 4 times more likely to die from childbirth complications than their white counterparts

- Black children across the world get suspended for hairstyles that “disrupt learning” or “do not meet the criteria” for school policy

- My CV is more likely to be accepted if my name is white-sounding.

The sad thing is that the list goes on. The majority of our society are unaware that such racism and discrimination occurs, or that it is even embedded in the very institutions put in place to protect us. Black History Month can shed light on these discrepancies, educate and celebrate the community. Therefore, let us hold it with great importance in our social calendar.

References

https://www.blackhistorymonth.org.uk/article/section/bhm-heroes/the-bristol-bus-boycott-of-1963/

www.mappingviolence.org

https://www.endofound.org/the-disparities-in-healthcare-for-black-women

https://bwhi.org/policy-development/

https://www.pnas.org/content/113/16/4296

https://www.chroniclelive.co.uk/news/tv/bgt-ofcom-complaints-amanda-nabil-19057535

https://womensinitiativeedmonton.ca/black-history-month/

Malone Mukwende - Failing to start: Why we accept mediocrity and how to change!

Mon, 12 Oct 2020 12:51:26 GMT

Hi, my name is Malone and I'm a third year medical student at St Georges University of London. I am one of the Co-authors of mind the gap which is a clinical Handbook of signs and symptoms in black and Brown skin. The summer has been quite hectic since I posted the work of Mind the gap on my Twitter page on the 18th of June 2020 as ‘Mind the Gap’ has been viewed over 100 million times with notable mentions from celebrities such as John Boyega, Lupita Nyonggo and Priyanka Chopra.

I noticed there was the issue at medical school on the lack of teaching in darker skins on arrival this was very concerning to me because I was almost unable to even spot signs and symptoms on myself. I knew that if I couldn't do this on myself then how am I expecting myself to be able to do this on others. With increased awareness on some of the healthcare disparities that exist in the UK such as black women being five times more likely to die during childbirth and black men more likely to be sectioned under the Mental Health Act it became apparent to me that something needed to be done.

I have spoken about ‘Mind the Gap’ on various platforms so I won’t repeat the same story again for this platform. Alternatively, I'm going to use this platform to speak about the impacts that it has had thus far on both myself and the world.

Over the past two months had featured in many news articles such as the Washington post, Sky News, ITV News, BMJ, and the CBC in Canada. This has led to a great amount of attention surrounding my name. Unfortunately, with this attention has come a lot of hate. Many people we’re unaware of the need for ‘Mind the Gap’ and it almost felt like I was creating unnecessary agendas and given the political climate of the world in 2020 many people felt entitled to try and stifle our attempts. Of course, everybody is entitled to their own opinion and thoughts however many would go out of their way to express their thoughts by sending hateful messages and emails. As a student who is just trying to do something positive this of course would get me down, however one thing that I knew is that change will always be met with resistance. It was clear to see that some people hating the fact that ‘Mind the Gap’ was having such a good impact.

Before the ‘Mind the Gap’ Handbook was released I could see a shift and a hyper awareness from the world that we need to do something about the lack of diversity in imagery. I could see that many news articles were now starting to include signs of how conditions present in COVID-19 on darker skin. This was extremely positive as I didn't believe that my co-authors and I could have such a big impact on the world.

My aim with this blog post is to illustrate how resistance is a by-product of change. I want to use this opportunity to help people acknowledge that sometimes your ideas won't always be met with open arms however don’t let that get you down. This message is for anybody who may have an idea but is almost holding themselves back due to fear of not being accepted. I think it's so important to have faith in your own work and then from there everything else will fall into place.

To keep up to date with mind the gap and associated posts please follow my social media. Instagram @malone_187, Twitter: @malone_mk

Catch us interviewing Malone on Tuesday 27th October at 7pm over on our instagram @acmedicalmentors

Black Impact in Medicine: How this shaped the journey to medicine for me

Tue, 06 Oct 2020 18:09:01 GMT

“Accomplishments have no colour.” - Leontyne Price

This statement says a lot in a few words - partially true in my opinion. For example, when we turn on lights or boil a hot cup of tea, we never sit down to think about the racial background of the respective inventor/creator. However, have you ever wondered what contributions our own black people have brought to the table? What about in the realm of medicine? We don’t learn much in school apart from how black people were oppressed. However, at notable times of the year such as Black History Month, we now have a chance to celebrate how far black people have come.

I’ve always wondered if I would have been able to live through the hardships and racial injustices our ancestors did - would I have the emotional strength to still pursue the goals and dreams I have now? History shows that both black women and men went against the grain dating all the way back to slavery, unwittingly paving the way for successors today. In 1721, an enslaved African named Onesimus, described the African method of inoculation against smallpox which was later used to protect American Revolutionary War soldiers. In 1864, Dr. Rebecca Lee Crumpler was the first African American female to earn a medical degree, and to graduate from New England Female Medical College, Boston.

I’ve come to learn the key things that have driven black people at the time of such prejudice: fearlessness and the will to want change. James Durnham, in 1762 began his own medical practice after buying his own freedom from slavery. He was owned by a number of doctors and was able to improve his skills to where he had his own flourishing practice, however he was later restricted because he did not have a formal medical degree. Some could argue that he was the first African-American doctor in the United states.

Black impact in the US revolutionised changes for black people all over the world. We can never forget the impact of Black British nurse Mary Jane Seacole. Many of us know of her but sometimes the depth of the selflessness of people like her gets lost in history, especially those who were not native to the UK. Born and raised in Jamaica, she helped treat those affected by the Kingston cholera pandemic. She then came to England in 1854 after the start of the Crimean War to join the British War Office to go and help wounded soldiers in Ukraine. After being rejected, she decided to raise money for herself to travel to Balaclava, Ukraine and set up the British Hotel where she could tend to the injured soldiers. She also visited the battlefield to treat the wounded and became known as ‘Mother Seacole’.

Her story shows us that when there is a will - there’s a way, despite the circumstances. It could be argued that in today’s era we have many more privileges than those who lived before us, but even so, you can’t help but feel inevitably discouraged sometimes along your medical journey. Now the question I always ask myself is ‘what if my story is the one that also paves the way for others?’ and ‘If I give up, what does it mean for others that come after me?’

Other examples of black contributions in medicine include Dr John Alcindor in 1873 who came from Trinidad. After graduating, he carried out research and published articles on cancer, influenza and tuberculosis and worked to prevent syphilis and tuberculosis in Great Britain.

Dr Harold Moody also came from Jamaica and studied in King’s college but due to racial prejudice, was not able to secure a job in a hospital. Despite this, in 1922 before the NHS was established, he offered a free health service to poor families.

There are many black pioneers of dentistry such as William Thomas Jefferson who joined the army as a dentist and oversaw the dental health for all of the soldiers all whilst serving as a lieutenant. He made several efforts to set up a regimen for black men at his dental practice. George F. Grant found interest in the dental field after being born to slaves and doing deliveries for a dentist. He later studied at Harvard Dental School and made several contributions to cleft palate procedures. He was the first black dentist to teach at Harvard Dental School.

“If you think you're too small to have an impact, try going to bed with a mosquito in the room.”

- Anita Koddick

Without these individuals and many others, it is clear that a vast majority of things we read in our textbooks today would be non-existent. If anything, the message is clear: Persevere despite the hardships we face as black people in society, even in present time. You just never know the magnitude of your impact.

- Emefa Vondee, 6th year medical student

References

https://guides.mclibrary.duke.edu/blackhistorymonth/chronology

https://dentalsave.com/blog/a-tribute-to-black-dental-pioneers/

My dental journey so far

Fri, 28 Aug 2020 11:43:21 GMT

Where do I even start?

This journey was not an easy one AT ALL. It’s been a long and untraditional journey but nevertheless one of the most rewarding things I’ve ever done.

LESSON #1: Even When Things Are Going Great, Don’t Get Comfortable

In Year 11, I did 10 GCSE’s and managed to get: 4A’s 2A*, 3B’s and a C in Physics which to this dayyyy still baffles me, the subject just has me like

Anyways, in Year 12, I got 3 C’s in Biology, Spanish and G+P and a U in Chemistry. Guys. I have never been so distraught in my LIFE.

I thought the world was ending. I thought I couldn’t show my face in school. But more importantly I knew my chances of getting into Dentistry with those grades were so slim.

Looking back, I definitely should’ve retaken Year 12. Would I have achieved better grades? Who knows. But I denied myself a 2nd chance because I was scared of the taboo of retaking and this leads to:

LESSON #2: Don’t Let People’s Opinions Stop You From Achieving Your Dreams/Goals – this includes your peers, teachers, Head of Year��, parents etc

I was allowed to continue to Year 13 so I did, dropping Chemistry. And if I’m honest not much changed, I still struggled, I still found it hard and I still wasn’t putting in 100%. The plan now was to study Biomedical Sciences then apply for dental school after.

I made Kent my firm and Aston my insurance, both giving me a conditional offer of 3B’s. Results day came and I cried yet again. My UCAS offers were non-existent (UCAS is the admission process for university in the UK) so I knew I didn't get 3B’s.

Lo and behold I was right and saw a C in Government and Politics and 2 D’s in Spanish and Biology. I was looking at my paper thinking howww when I knew exactly how.

So I applied for clearing and got a place for Biomedical Sciences with a Foundation Year (as my grades were low) at the University of Hull. I was so relieved that I had got a place that I didn’t even deep that Hull was 4 HOURS AWAY! Had I even heard of the place?!

UNIVERSITY

This now made my original journey of 5 years at uni turn into a NINE year journey, university and more specifically Hull was my saving grace and a blessing in disguise. I decided to apply in my final year at Hull to dental school in the UK at KCL, Bristol, Aberdeen and Leeds. KCL, Bristol and Aberdeen all required UKCAT to be taken as part of their admission process – so I had to take the wretched test.

I used Medify , Medic Mind and the Get into Medical School – 1250 UKCAT Practice Questions

book by ISCMedical to revise. My UKCAT score was 580 which was well below the average of 640 that year. Leeds required the BMAT. I found the BMAT easier than the UKCAT but even then, my score of 3.8 was still below the average of 5. Yet, I STILL decided to apply lool.

Bristol was actually ruthless and declined my application like 5 days after I sent my application through UCAS��. KCL was next, declining my application in November. Low-key I was trying to keep it together and not let the fact that 2 dental schools had rejected me upset me. But I still had hope and faith that God had a plan for me, no matter how it panned out.

In late November, I decided to dabble a bit in the idea of applying abroad and I came across a website called A Star Future . After a lot of searching on the European schools they represented, I decided to apply for Dentistry at the Universidad Catolica de Valencia (UCV) in Spain. I sent my personal statement, my GCSE and A Level grades and my university transcript/final predicted grades via email to the agency. Literally 3/4 days later, I received a conditional offer based on me passing my degree with a 2:1/1st. Even though I had finally got an offer, I wasn’t ecstatic because I thought I’d feel more accomplished getting into dental school in the UK. Silly, right? Which leads to my third lesson:

LESSON #3: Don’t Discredit Your Accomplishments, Not Matter How Big Or Small You Think They Are – Dentistry is a highly regarded and respected degree, no matter where it is studied so don’t let location or people/your OWN opinions diminish that.

Early January, whilst I was revising for my final exams, I received an interview offer from Leeds and I was over the moon. I thought “yeahh this is it, I’ll smash the interview and then I’m practically in“. I left the Leeds interview feeling really confident about the outcome.

LESSON #4: Don’t Limit Yourself! – I could have easily not applied to Leeds because of my A-Levels and my low BMAT score, yet I still did and was given an interview. You never know until you try!

Even though I thought it went well, I received my rejection email from Leeds and Aberdeen. It felt like my chance of studying my dream was unattainable and I totally disregarded my offer in Spain because I was adamant that I could get another interview again.

After speaking to my parents about the next step, I decided to make a bold decision to study in Spain. There was no certainty that I’d get an interview if I applied again in the UK, and I literally had the opportunity to study Dentistry staring at me in the face. Oh yeah,

LESSON #5: BELIEVE IN YOUR OWN SAUCE – It all starts with your mindset and believing in yourself.

I didn’t let my grades define me because at the end of the day, they are just numbers and the alphabet from A-G. Having said that though, here comes the next lesson ☺️

LESSON #6: PERSEVERE

Yes, I am 22. Yes, I’ll graduate at 27 rather than 23. But I have already accomplished so much and there’s still more to come. The past 6 years have disciplined, motivated and matured me so much that perhaps I wouldn’t have succeeded studying dentistry at 18.

Everything does happen for a reason, so no matter what your passion is, or how far you think you are from achieving it, it can definitely happen if you put your mind to it.

I hope my journey has been a testament of this x

I write this post as a 1st year DENTAL student on my sofa in the amazing city of Valencia.

Studying as a graduate entry medical student

Tue, 11 Aug 2020 16:33:42 GMT

Medicine is all I have wanted to do since I was about 15. I never had a concrete reason why, but I would say I’m quite an intuitive person, and my spirit just took to medicine, it fit for me. I failed to secure an offer the first time round, so after achieving a first-class degree in Biomedical Science, I currently study Graduate Medicine at the University of Birmingham.

Studying medicine as a Graduate is rewarding, and for the most part very enjoyable. I can’t see myself doing anything else. However, it has brought certain challenges which I wanted to share in this post for anyone that can relate to this, whilst giving a realistic idea for those considering it.

Firstly, it is really intense, I will be studying consecutively for 7 years. Within that time, I have completed one degree, applied for Graduate Medicine (which is extremely competitive) and studied the entire 2-year preclinical course in less than a year. This is why it is so important to take breaks and be realistic with your workload to avoid burning out. I have multiple outlets which give me a breather and allow me to enjoy myself outside of medicine. I play netball, spend time with loved ones, run ACMM, attend every soca event possible and countdown to carnival every year. These things allow me to have a life outside of medicine which is crucial.

Also, the funding for the Graduate Entry Course is substantially different to the undergraduate course. For the first year, it requires a contribution of over three thousand pounds, and in subsequent years you get a combination of student finance and the NHS bursary which is usually less than your previous student finance loan. It is therefore common that there is a financial pressure on graduate students, which is why many have a year out prior to beginning the course in order to save. I had an offer straight from Biomedical Science so was not able to do this. Unfortunately, financial pressure is not uncommon amongst students in general, but it is an even more important consideration for Graduate Entry Medicine.

As a graduate, you are older than a lot of your peers – meaning your age mates are usually working, and earning money whilst you are still relying on student finance England to drop money that doesn’t cover your rent. However, I work during the holidays and sometimes throughout my degree to make sure I can still live and enjoy life as much as being at university will allow. This comparison is hard to deal with at times, especially when your peers may have the time and money to do things that you can’t. It can be frustrating and draining to say no to things but I try and remind myself that it is only me that will be crying on the wards if I don’t prioritise my work or stretch myself too thin. I am lucky, I have an amazing support network who understand my situation and support me as much as they can. It is easy to resent your situation when you feel behind, but I always try to remember that I am exactly where I am meant to be.

Despite these challenges, studying medicine is a huge privilege. Speaking to patients who remind you of your relatives, and knowing you can make a personal difference to them is so rewarding. The silent support and respect you receive from strangers when you say your career path reminds you of its worth and value to the community. As a graduate, I have found I am more equipped to deal with the difficult parts of medicine – the sometimes draining hospital environment, seeing sick patients and upset families, and the lack of resources. My journey hasn’t been the easiest, but despite it being one of the hardest things I’ve ever done, I know once I graduate, it will be the best thing I’ve ever done.

Words to my younger self

Mon, 03 Aug 2020 17:41:12 GMT

2020 has been a rollercoaster of a year. It feels like with each progressing month another level of Jumanji is reached. This year was one I had so many plans for, particularly this summer, the summer I was to graduate and finally become a doctor after 8 years of university. There were times in the previous years where I just wished I was finished; I wished I was graduating already. At times I envied those graduating whatever year it might have been.

As the saying (or the pussycat dolls song) goes, be careful what you wish for, because you just might get it. In April 2020, my wish came true. The circumstances however were those beyond what my mind could even imagine, a virus taking countless lives, keeping loved ones apart, sweeping the globe.

If you told me three months ago that today, as I’m writing this post, I would be in my first working week as an employed doctor? I would not have believed you. Three months ago I had only just written my finals, celebrated with travel, well, I came home to a different world than when I stepped on the plane to leave.

Class of Covid-19 as I like to affectionately call us, has been called up for duty. Who knew a global pandemic chose the year in which I was due to qualify to make its entrance into the world. I write this open letter to my younger, student, self and other medical students (both current and future) to say this.

Don’t wish away where you are now, because tomorrow might not be what you expect. Each season in life has its purpose. The times I cried because I didn’t get any offers to study medicine? Well they led to me finding joy in Midwifery. The days when I worried how I would pass my exams, study and find go to work; they led me to be resourceful and manage my time. Not everyone believes in fate, or in destiny but I believe all those times and moments where leading up to this season, starting as a doctor in the most extraordinary of circumstances. These days will be written about in the history books and we are living through them.

There is a lot of uncertainty for medical students and those that were planning to apply this coming September. There is restructuring of exams, cancelled placements, virtual lectures and other socially distanced changes. Take all the anxiety and worry that might come with the uncertainty and consider this an opportunity.

Take hope and comfort in where you are now, for it is preparing you for where you might be tomorrow. Don’t wish away the experiences you are having, embrace the hurdles because they train you to jump higher. I know it is easy for me to say because now I am at the other end of this journey but with every ending there is a new beginning, different challenges, more lessons.

More on early provisional registration of final year medical students and its impact on medical students

Covid-19: medical schools given powers to graduate final year students early to help NHS

Joint statement: early provisional registration for final year medical students

Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic

The Impact of COVID-19 on Medical Education

Clerking patients with Mania

Sat, 04 Jul 2020 10:58:40 GMT

Earlier this year, I had a six-week placement in psychiatry and had the privilege interacting with many admirable psychiatrists who went above and beyond for their patients and with patients who kindly shared their stories and struggles with me. I knew this placement would be unlike any other I had been on and in this article, I recall the first time I clerked (interviewed) a patient with mania… and it was definitely a unique experience…

Disclaimer: All initials and some details have been omitted/changed to preserve patient anonymity.

Patient KL is a 16-year-old, male who was top of his class but in the last 6 months, this all changed as his behaviour changed from ‘calm and likeable’ to ‘angry and irrational.’ He stopped going to school for 2 months and spent all his time on his laptop, planning how to end world poverty and become a billionaire. He fell out with his family and in the days leading up to his forced admission, he hadn’t showered or ate in days; a common occurrence in severely manic patients.

On interviewing him, he exhibited delusions of grandeur, concrete thinking, flight of ideas, pressured speech, auditory second person hallucinations and lack of insight. For the non-medics, this means he believed God and angels spoke to him and that he had been appointed by God to end world poverty. When talking about this, he spoke in a very fast, uncontrollable way and did not doubt these ideas at all.

During the consultation I felt an array of emotions, including curiosity, confusion and sadness.

Curiosity: As it was the first time, I had taken a history from somebody with mania, it was amazing to see grandiose delusions, an abstract concept I had only seen in textbooks, come to life. I wanted to know more about his ideas and where they originated from. Some of his ideas, regarding business and education, I’d find myself agreeing with until he’d then add something completely bizarre, thus reminding me of how unwell he was. I wondered how psychiatrists reserved from getting pulled into a patient’s convincing spiels.

Confusion: I was confused as to what had caused/triggered this manic episode as he didn’t seem to have any past personal or family psychiatric history nor alcohol or drug use. In fact, he had so many protective factors against a serious psychiatric condition, such as supportive family, good education and more. My confusion at the seemingly random nature of his illness led me on to sadness…

Sadness: The lack of any risk factors showed me that anybody can be struck by a mental health imbalance. This patient was a young man aspiring to get into university and I was saddened by the fact that he was so ambitious and hard-working, but this episode had become a hurdle he must face as he steps into adulthood. I hope that this illness does not throw him off his trajectory but instead can be used as fuel for his aspirations.

Amused: Although this might sound cruel at first but I was not laughing at him but rather with him. During the consultation, we were able to build rapport as he still made jokes and these breaks of laughter allowed us to connect, even if only briefly, and reminded me of the human connection between physician and patient, a connection that sparks off real recovery as it allows you to truly treat the person in front of you and not just a bag of symptoms.

After interviewing KL, I had ample opportunities on my placement to interview other psychiatric patients, all with an array of disorders but all from different walks of life. This further affirmed that mental health can affect anybody. This patient happened to be south Asian and his family were completely, understandably in denial and shock that their son had turned from a high achieving student to a mental health inpatient. The intersectionality of mental health and race is an important aspect to be considered as there is a wealth of evidence that being of African or Asian origin is associated with poorer mental health outcomes. Whether that be due to lack of access, delayed presentation, lack of family support or difference in prescriptions and treatment.

As you can see from just this one encounter, that I experienced a whole breadth of emotions and it is for that fact that psychiatry is not for me. The 6-week placement left me emotionally drained and confused as you literally get thrown into patient’s worlds, from having to deal with very complex social issues to listening to their deep emotional turmoil. I have the utmost respect for psychiatrists because I honestly don’t know how they remain resilient in the face of very challenging patients with complex needs.

Jessica Katanga

5th year medical student

Discrimination in the NHS: Matt Hancock tightens policy

Sat, 27 Jun 2020 10:07:28 GMT

Racism against doctors is becoming an ever-increasingly spoken about topic. “28.5% of NHS staff said they had experienced harassment, bullying, or abuse from patients, relatives, or members of the public within the last 12 months”1. Fortunately, many NHS staff from a BME background are realising the fact that discrimination and racism from patients is unacceptable and are finding the confidence to report it.

Practice Business writes that “70% of surveyed trusts have reported an increase in such abuse”2. It doesn’t seem to be just staff though, as medical students have also been calling out the microaggressions that they experience on placement – some reporting being called “golliwog” and made to feel inferior, without any reaction from members of staff3.

Within the past few days, it has surfaced that NHS staff are now equipped with a strengthened power to remove any abusive patients from hospital as soon as their treatment can safely be terminated. This news comes as NHS England reports a 1.4% increase in staff facing discrimination (notably racism) from patients since 2015 – and that shocking data does not even include GP staff4.

However, it seems that many trusts have already implemented similar policies in an attempt to exhibit a ‘zero tolerance’ attitude towards racism. This was exemplified by one such event in the summer of 2019 in which a patient was banned from Wigan Infirmary after demanding to be seen by a white doctor5. In November 2019, a leading Trauma and Orthopaedic surgeon Mr Radhakrishna Shanbhag6 spoke very openly about being asked to be seen by his white colleague – and described feeling “worthless” and “unable to refuse” the patient’s request.

The candour of Mr Shanbhag’s words sparked huge discussion about the abuse doctors face whilst working on a day-to-day basis. To which the Health Secretary, Matt Hancock replied:

'No person should ever feel worthless because of racial abuse. Particularly the extraordinary individuals, like [Mr] Radhakrishna Shanbhag, who have dedicated their lives to improving the lives of others'

North Bristol NHS Trust has recently introduced a ‘red card’ policy7 with the view of deterring abusive behaviour from patients which includes racist and sexist language gestures or behaviour, threatening and offensive language and alcohol/drug abuse. Patients engaging in such behaviour will be issued a “sports-style disciplinary yellow card” as a warning and any continuation will lead to a ‘red card’ in which a patient will be removed from the hospital as soon as safely possible.

It is important to also recognise the necessity of stripping away the endemic structural discrimination against BME medics that is found within the NHS system and medicine. The GMC stated that there is a “statistically significant” discrepancy between pass rates of BME doctors who are in speciality training vs their white colleagues. With average pass rate for UK white doctors being 75% in 2014-15, and 63% for BME doctors – there is a well-defined need for improvement of these statistics and to ‘level out the playing field’. It has also been found that doctors from the most deprived backgrounds received a higher proportion of unsatisfactory outcomes – 13% compared to the average of 5%8.

These sobering figures underline the struggle felt by many BAME NHS staff in trying to feel equal to the rest of their colleagues. It is reassuring, though, to know that not only is this topic being spoken about more frequently, but that there are organisations actively working to combat it e.g. the BMA with its charter to help medical schools deal with racism3. I hope to see all hospitals applying a ‘zero-tolerance’ approach, and that NHS staff from all backgrounds work synergistically to enforce this approach.

Sources:

1 -

https://www.medscape.com/viewarticle/925344

2 -

https://practicebusiness.co.uk/can-i-have-a-white-doctor-for-the-operation-racist-abuse-against-nhs-staff-almost-triples/

3 -

https://www.bma.org.uk/news/media-centre/press-releases/2020/february/racial-harassment-in-medical-schools-is-barrier-to-students-becoming-doctors-of-tomorrow-says-bma

4 -

https://www.medscape.com/viewarticle/925344

5 -

https://www.wigantoday.net/news/racist-wigan-patient-banned-after-appalling-demands-be-treated-white-doctor-ae-958103

6 -

https://www.bma.org.uk/news/2019/november/senior-doctor-speaks-out-about-racial-abuse

7 -

https://www.nbt.nhs.uk/news-media/latest-news/north-bristol-hands-red-card-racism

8 -

https://www.bmj.com/content/354/bmj.i4100

Unconscious bias within the healthcare sector

Wed, 17 Jun 2020 11:06:05 GMT

Introduction

The provision of equal healthcare for all patients, irrespective of their identity is an important pillar of many healthcare systems (Jamison D et al., 2006), this core value of patient care is often compromised because of the presence of unconscious bias. Unconscious bias is the product of associations made outside of conscious awareness (stereotyping) that lead to the negative treatment of groups of people based on “irrelevant” characteristics such as race, gender, age and so on (Fitzgerald C and Hurst S, 2017).

Implicit racist bias and the effect on health outcomes

In this current environment of understaffed healthcare systems, time pressured consultations and routinized procedures, medical professionals still aim to maintain the intricate necessities which aid in enrichment of patient-physician relationships and interactions. It is of the general consensus that the patient-physician relationship does have a statistically significant effect on health care outcomes (Griffin S et al., 2004) (Harrington J et al., 2004)(Kelly J et al., 2014).

In contrast to racially concordant consultations (physician and patient of the same race), racially discordant consultations have been recorded as being less positive, and have been characterised by less patient trust, less effort invested into building of patient physician relationship and less joint decision making (Johnson R et al., 2004)(Cooper L et al.,2003)(Simonoff L, 2006)(Koerber et al., 2004). It may be of little surprise therefore, that implicit racist bias has been pinpointed as responsible to some extent for the disparity in health care outcomes between minority and non-minority ethnic groups. These findings are supported by studies in Social Science and Medicine by Nao Hagiwara and colleagues (2013), who found that physicians with a high implicit racist bias score had a tendency to dominate most of the interaction time between themselves and patients during consultations and to use language that implied a presence of power disparity. The presence of implicit racist bias therefore has the power to degenerate the patient-physician relationship, affect the efficacy of patient consultations, and by domino effect, the outcome of such consultations.

Implicit racist bias has also been shown to have more direct effects on patient health outcomes. Particularly pertinent examples of this pertain to physicians’ perceptions of differing levels of pain thresholds between white and black patients (Hoffman K et al., 2016). For many centuries, there has been an overarching belief that black people’s bodies are biologically and fundamentally different from those of their white counterparts (Morning A, 2011). This belief manifested in devastating ways in the past, such as during slavery when black men were believed to be more powerful and efficient at manual labour than white males, and hence were treated as valuable commodities for the purpose of work.

‘Research shows that these biological misconceptions are correlated with the implicit racist bias that manifests within our society, with pain perception in medical practice being just one of many examples of this (Williams M and Eberhardt J, 2019).’

Combatting Implicit racist bias in medical practice

Medical associations have the responsibility of combatting implicit racist bias, this starts with making those within the medical practice aware of their implicit bias views and guiding them with practical methods and solutions as to how they can reduce their bias. Burgess et al (2007) go further to suggest that informing medical professionals of the fact that stereotyping and implicit bias are “normal aspects of human cognition” may make them more comfortable with learning about this phenomenon and its effects within medical practice. Although I partly disagree with this statement, as I believe it has the potential to breed complacency and comfort with one’s own implicit (racist) bias, this statement is duly supported by studies which show that a large fraction of the population tends to feel uncomfortable when talking about race and racism (Martin C, 2018).

Dr Augustus White’s book on “Seeing patients: unconscious bias in health care” suggests a solution as simple as medical professionals having a basic understanding of cultures that patients come from to help reduce their implicit racist bias. This solution points to the issue of a lack of diversity of medical professionals. If there was greater diversity within the healthcare sector, this would likely give opportunity for expansion of medical professionals’ exposure and by effect their understanding of other cultures.

Dr White appeals to medical professionals to remember to assiduously practice evidence-based medicine (EBM); A core element of modern medical practice. (White A, 2011)

EBM incorporates research evidence, clinical expertise and importantly patient values and should leave no room for implicit bias to alter the objective quality of care received by one patient compared to another (Masic I et al., 2008).

Conclusion

To conclude, implicit racist bias indeed exists within the healthcare sector and its effects defy the very pillars and core practices of modern-day medicine.

Unconscious bias is arguably harder to tackle than conscious bias; the intentional unfair treatment of groups of people, as it requires an individual’s willingness to change their behaviour regardless of their awareness of their bias, when the effect of their bias is exposed.

In an era where health equity is a continuous goal, more needs to be done to combat it.

Bibliography

Blasi, Z., Harkness, E., Ernst, E., Georgiou, A. and Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review. The Lancet, 357(9258), pp.757-762.

Burgess, D., van Ryn, M., Dovidio, J. and Saha, S. (2007). Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology. Journal of General Internal Medicine, 22(6), pp.882-887.

Cooper, L., Roter, D., Johnson, R., Ford, D., Steinwachs, D. and Powe, N. (2003). Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race. Annals of Internal Medicine, 139(11), p.907.

Douglas K (2019). Educational access digital subscriptions | New Scientist. [online] Available at:

https://institutions.newscientist.com/article/mg23631560-600-effortless-thinking-why-stereotyping-is...

[Accessed 25 Nov. 2019].

FitzGerald, C. and Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(1).

Griffin, S. (2004). Effect on Health-Related Outcomes of Interventions to Alter the Interaction Between Patients and Practitioners: A Systematic Review of Trials. The Annals of Family Medicine, 2(6), pp.595-608.

Harrington, J. (2004). Improving patients' communication with doctors: a systematic review of intervention studies. Patient Education and Counseling, 52(1), pp.7-16.

Hobermann (1997). Darwin's Athletes: How Sport Has Damaged Black America and Preserved the myth of race

Hoffman, K., Trawalter, S., Axt, J. and Oliver, M. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), pp.4296-4301.

Jamison, D., Breman, J., Measham, A., Alleyne, G., Claeson, M., Evans, D., Jha, P., Mills, A. and Musgrove, P. (2006). Pillars of the Health System. The International Bank for Reconstruction and Development / The World Bank, [online] p. Available at:

https://www.ncbi.nlm.nih.gov/books/NBK10265/

[Accessed 22 Nov. 2019].

JL, W. (2019). Biological conceptions of race and the motivation to cross racial boundaries. - PubMed - NCBI . [online] Ncbi.nlm.nih.gov. Available at:

https://www.ncbi.nlm.nih.gov/pubmed/18505316/

[Accessed 22 Nov. 2019].

Johnson, R., Roter, D., Powe, N. and Cooper, L. (2004). Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits. American Journal of Public Health, 94(12), pp.2084-2090.

Kelley, J., Kraft-Todd, G., Schapira, L., Kossowsky, J. and Riess, H. (2014). The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 9(4), p.e94207.

Koerber, A., Gajendra, S., Fulford, R., BeGole, E. and Evans, C. (2004). An exploratory study of orthodontic resident communication by patient race and ethnicity. Journal of Dental Education, [online] 68(5), pp.553-562. Available at:

http://www.jdentaled.org/content/68/5/553.long

[Accessed 22 Nov. 2019].

Morning A (2011). The Nature of Race: How Scientists Think and Teach about Human Difference By Ann Morning

Medium. (2018). Why Are White People So Bad At Talking About Race?. [online] Available at:

https://brightthemag.com/white-fragility-why-are-white-people-so-bad-at-talking-about-race-robin-dia...

[Accessed 22 Nov. 2019].

Masic, I., Miokovic, M. and Muhamedagic, B. (2008). Evidence Based Medicine - New Approaches and Challenges. Acta Informatica Medica, 16(4), p.219.

Siminoff, L., Graham, G. and Gordon, N. (2006). Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Education and Counseling, 62(3), pp.355-360.

White, A (2011) “Seeing patients: unconscious bias in health care” (2011)

The impact of racial injustice on a future doctor.

Wed, 03 Jun 2020 21:56:49 GMT

As a young child, living as a minority abroad, I always felt a sense of otherness. I was not quite sure why, but I knew I was different from my white counterparts. As I aged, this sense of otherness became more poignant as I realised my place in society. Having always wanted to become a doctor, I don’t remember a single teacher at school encouraging me when my desires were shared – more often than not I was met with “why don’t you think about other career options, medicine is very difficult”.

In wider society, I was not represented. In adverts, there were never women who looked like me and, in most UK TV programmes black people were rare or insignificant. I never once saw a black doctor, black lawyer or successful black person represented. I only saw black people struggling, either as slaves, in poverty or in gangs. I was a silent ethnicity in the media unless it was negative. I watched black boys I knew being harassed by the police and never came across a black teacher or lecturer – never had a motivator who wanted to see me win because I reminded them of their niece or cousin.

As I grew older, I completed a placement as part of my Biomedical Science degree and was met with both ignorance and racism. I would casually hear colleagues using the word “coloured” in the staff room. Constantly have people question why my hair had gone from 20” to 12” and whether they could touch it and say “Ooooh it’s so springy”.

As an adult, I have constantly been called “sassy” or “feisty” when I simply stand my ground, I have been seen as the spokesperson for everything black when in a room of all white faces. I am constantly seeing the videos of black men and women being wrongfully charged, wrongfully convicted, wrongfully abused and wrongfully killed by the system to which they pay their taxes.

I am always wary of travelling to certain places because of the possible racism in that area and taking the risk of being stared at (or worse) whilst I go for dinner or sit at a bar.

As a medical student, I am surrounded by other students that not only don’t look like me but have been brought up completely different to me – some who have never met a black person in their life. For example, a fellow medical student said to me - “Wow you managed to do two braids in your hair, did that take long? Your hair is just so…bouncy”. I am constantly having to manage a racist curriculum where the epidemiology of disease in black people goes unmentioned unless it is diabetes or sickle cell. Being shown a rash on a white patient and being told that this is how you diagnose….but what about our black patients?

I have heard doctors say “Those sickle patients just come in demanding medication, a lot of them just want pain meds” and know that if it had been a different demographic, those comments would not have been so freely thought or made.

I have experienced patients and doctors constantly making much more eye contact with my white counterparts than me whilst on the wards. I am always mistaken for the nurse although I’m not wearing a uniform and have a stethoscope around my neck.

And the deaths. The deaths of black people who could have have been your cousin, your aunt, your brother, your nephew. Deaths not only so harrowing and unjust to start with but that then go without punishment. Another black life lost with no repercussion.

My experiences are those that many of my fellow black medical students and doctors have experienced. My stories echo so much truth for so many others which shows the work that desperately needs to be done. Statistics back up the impact of these experiences, the impact of this bias on both attainment and mental health.

1. Black women being 5x as likely to die from childbirth

2. Medical school curriculum showing how diseases present on white skin

3. COVID:19 - recent reports of black people being more likely to die from the disease

4. Black female doctors are paid less compared to their white counterparts

As a black woman, racism isn’t an abstract idea that seems cruel and unfair. Racism underpins my opportunities, my daily thoughts, my experiences, my salary, my self-worth and ultimately my life. This is why, at ACMM, we stand with everyone fighting for black people to feel safe, valued and recognised as people. For us to have the opportunity to achieve and to breathe just like everyone else.

Resources:

NHS Pay Gap report 2019
Medical apartheid - The dark history of Medical Experimentation on black Americans from Colonial times to the present
UK Confidential enquiry into maternal deaths
MBRACE-UK Report 2019
COVID-19 Public health England report
Mental health and explaining racism: https://metro.co.uk/2020/02/25/psychological-impact-constantly-explain-racism-12147969/
COVID-19 report: COVID-19: review of disparities in risks and outcomes.
US: https://blacklivesmatters.carrd.co/ #
US bailout funds (equal distribution): https://secure.actblue.com/donate/bail_funds_george_flo yd
UK: https://docs.google.com/document/d/10iIz_pFB8DzPkwddc8dcmJdJ0ZMITfTs7lvs4uyusZk/mobilebasic

Resources (including books and podcasts):

• https://docs.google.com/document/d/1aYPe21Rve3YPpozxZJE4C3WfWCvkvo_pyXkdzOARxho/mobilebasic

• https://docs.google.com/document/d/1ko1dRVSUtpDntIZ5SrewALLhcMDuhe69Om31oOHIkh8/edit

• https://drive.google.com/file/d/1-NVcFu9fFS-htYEo4hsQqMXemLJRXt1M/view?usp=drivesdk

Decolonising the medical human body:

• https://discovery.ucl.ac.uk/id/eprint/10090977/1/Lokugamage_Decolonising%20ideas%20of%20healing%20in...

• https://www.youtube.com/watch?v=pcj99LLYWqA&list=PLEDbLg0JnsgywL8CgBsMhTTkbY5UP-BTD&index=7&...

COVID-19: Insight into the testing lab

Sun, 24 May 2020 12:12:51 GMT

Hi, I’m Ayo, a 26-year old Biomedical Scientist, Business owner and Beauty lover. I work in the field of Medical Microbiology with extensive experience in Molecular Biology pertaining to Virology. Initially, I started off my career working for a Public Health Laboratory which was heavily research based, I was able to gain extensive training from senior research colleagues. My job role involved providing resistance testing for HIV, HIV subtyping via Sanger Sequencing, Hepatitis C Virus Whole Genome Sequencing and routine cell culture of Herpes Simplex Virus.

My time working in a Public Health Laboratory gave me an insight into the significance of outbreaks in relation to laboratory testing, however, I was still interested in working in a diagnostic setting. This led me onto a career within the NHS. Joining the NHS in the middle of a pandemic isn’t ideal and COVID-19 took precedence over all routine diagnostic work.

Coronaviruses are RNA viruses that cause several diseases involving respiratory, enteric, hepatic and neurological systems among humans (Zumla et al., 2016). Testing involves detection of viral RNA within patient samples. The methodology involves two stages, Viral Total Nucleic Acid Purification and Real-Time PCR.

At onset of the disease, the main manifestations of COVID-19 are fever, continuous dry cough , shortness of breath, In severe patients; complication of the virus include severe acute respiratory syndrome, coagulation dysfunction and pneumonia. Asymptomatic individuals or those with mild disease are able to spread COVID-19; therefore social distancing is required in order to prevent further transmission of this devastating disease. (Li et al., 2020) (BMJ Best Practice, 2020).

Firstly, oropharyngeal swabs are received in viral transport medium, this medium is able to maintain specimens and minimize bacterial overgrowth from time of collection to the processing of the specimen. Firstly, nucleic acid purification is performed in four important steps; effective disruption of cells, denaturation of nucleoprotein complexes, inactivation of nucleases such as RNases and DNases and to free target nucleic acid DNA and RNA (Tan and Yiap., 2009). The quality and integrity of isolated nucleic acid will directly affect downstream testing. RNA viruses tend to be more unstable with a shorter half-life than DNA, thus, requires processing immediately after extraction.

Once RNA has been obtained Real-Time PCR is performed. Real-Time PCR is able to detect two Coronavirus genes, open reading frame (ORF) and the nucleocapsid (N) proteins; these two genes are required in order to detect the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The validation process took one month to complete and approximately 85 previously tested samples were used in our study. Once validated I was involved in assisting the 100,000 tests per day target.

This unprecedented pandemic has been challenging mentally, as we have never seen such events take place in our lifetime. But I do believe that research is underway for a vaccine and hopefully we will obtain to regain control of this pandemic.

Written by Ayodele Osobu, biomedical scientist and business owner of @ayo_o_boutique. Edited by Omolara Akinnawonu.

Social Media Handle : @AYO_OX

@ayo_o_boutique

COVID-19: An ode to preparedness

Wed, 13 May 2020 16:53:41 GMT

A threat to global health has been discussed for many years, with the World Health Organisation (WHO) highlighting this unknown foe as ‘Disease X’. Disease X is defined as the “knowledge that a serious international epidemic could be caused by a pathogen” (1). This pathogen is undetermined, but this phrase is used in order to encompass all types of microorganisms that could cause a danger to our health.

Disease X could turn out to be the revival of an orthopoxvirus or perhaps a little-known neglected tropical disease. However, as of writing this in late April, the first Disease X may well be COVID-19 (caused by SARS-CoV-2) (2). Coronaviruses are single-stranded RNA viruses and usually cause tolerable symptoms seen in mild, cold-like illnesses. (4) However, in recent times, coronaviruses have risen to a global spotlight with previous infections of MERS and SARS due to their severe symptoms. This novel coronavirus is wreaking havoc across many borders. As a result, the public, medical students and professionals are closely examining our preparedness strategies towards this pandemic to protect our public health.

What is preparedness? In its literal definition, preparation is “a state of readiness” for an event. Preparedness is often seen in natural disaster plans for episodes of earthquakes or hurricanes, less commonly observed in the UK. Preparedness unifies proactively making choices to avert a hazard and risk management (3). When hazards are realised in vulnerable populations, they become a ‘disaster’. In the case of a global pandemic, preparedness could involve pre-emptively ordering supplies and ensuring that there is an adequate budget for research.

However, in this current situation, preparedness is no longer a useful term in dealing with this outbreak. One can no longer be ‘proactively’ trying to prevent an outbreak when it is already occurring. Society is currently reacting to this major disruption, whilst keeping an eye to other countries that may be days or weeks ahead of the UK’s timeline.

Is this pandemic a ‘never event'; something that should never have happened? Predicting outbreaks of disease can be arranged to an extent. For example, by using yearly data in tracking the flu, scientists can figure out likely strains in the following year. However, this is less straightforward; particularly as Covid-19’s methods of transmission are still being deciphered. Despite this, now is not the time for wishful thinking. If one traces our steps back to January, different decisions may have led to different outcomes. It is our reactions to this virus from now on that will impact the speed and scope of its spread.

Staying at home and social distancing are initiatives sold to the public in order to “flatten the curve”, reduce further infection, low decrease mortality rates and stabilise our healthcare systems. These public health measures can often go hand in hand with thoughts of ‘overreaction’ (5). Death tolls are still high and, despite infection rates falling, they show no definite signs of plateau. Recent protests against lockdown in America and Brazil are concerned with the harm quarantine is having on their respective economies’ futures (5,6). However, many countries are reaching pivotal points to which the trajectory of disease spread will be directed. As a result, it is imperative that governments do all in their power to reduce their caseload and deaths.

Broadly speaking, public health is to protect and improve the health of many, rather than just the individual. This is through preparedness strategies. Where this does not happen, efforts become reactions to the changing health landscape. This is to buy extra time before a vaccine or treatment is discovered.

There is no telling when this pandemic will ‘subside’. Our next steps will include evaluating our preparedness methods so that we will have the tools to prevent and mitigate against the next ‘Disease X’. For now, social distancing and research will be used to continue to curtail the spread of Covid-19.

Adanna Ewuzie

Year 2 Medical Student at Queen’s University Belfast

Reference list:

World Health Organization. Prioritizing diseases for research and development in emergency context. Available at: www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts . Accessed: 21 April 2020.
World Health Organization. (2020). Naming the coronavirus disease (COVID-19) and the virus that causes it. Available at: www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-di... . Accessed: 21 April 2020.
United Nations Office for Disaster Risk Reduction. (2017). Terminology. Available at: www.undrr.org/terminology . Accessed: 27 April 2020.
NIH NIAD. (2020). Coronaviruses. Available at: www.niaid.nih.gov/diseases-conditions/coronaviruses . Accessed: 22 April 2020.
German Lopez. (2020). We’re not overreacting to the coronavirus. Available at: www.vox.com/2020/4/17/21220786/coronavirus-pandemic-overreact-social-distancing . Accessed: 17 April 2020.
BBC. (2020). Coronavirus: Brazil's Bolsonaro joins anti-lockdown protests. Available at: www.bbc.co.uk/news/world-latin-america-52351636 . Accessed: 20 April 2020.

How European medical schools are tackling the COVID-19 pandemic

Sat, 25 Apr 2020 12:49:45 GMT

All the news about Coronavirus right now can be daunting. Particularly for students that study medicine at European medical schools. They may be finding it difficult to find the right information to understand what will happen to their education/academic semesters.

Current Situation in Eastern European Countries

On the 13th of March, the Bulgarian authorities declared a “State of Emergency” in Bulgaria and introduced several measures in response to the pandemic. With many schools and universities closing, sending students home, or offering online-only lessons.

The first two cases of COVID-19 were confirmed by the Bulgarian authorities on the 8th of March 2020, a 27-year-old man from Pleven and a 75-year-old woman from Gabrovo. The man is thought to have been in contact with Italian students but tested positive after being hospitalized for a respiratory infection. It is unknown how the woman contracted the virus, but authorities planned to test other individuals who were in contact with the two.

“On the basis of the Orders of the Minister of Health dated March 8th, 2020 and due to the evidence of the first cases of COVID-19 in the town of Pleven and Bulgaria the classes at Medical University – Pleven are stopped till March 14. The students are not allowed to leave their homes and visit any public places in the city such as cinemas, theatres, concert halls, fitness centres, restaurants and discos and other places with many people in closed spaces.”

Necessary measures have been put in place and have been quickly implemented as the number of cases rapidly rises in Bulgaria from 2 cases to 81 as of the 17th of March 2020. Although Eastern Europe is in the early stages, it is anticipated that things will get worse before they get better.

In Romania , universities such as G T Popa University of Medicine and Pharmacy in Iasi has also decided to shut down until the end of March and provide online lessons in the meantime. This measure may be prolonged depending on how the situation progresses in Romania.

Similar measures have also been taken in Latvia at our partner university Riga Stradins University. On 12 March the Latvian Crisis Management Council decided to suspend in-person teaching at all educational institutions. From 13 March to 14 April all education will be conducted only remotely.

What Does This Mean for Students Studying at European Medical Schools?

“Unprecedented situations” called so by Prof. Dr. Slavcho Tomov of Pleven Medical University. He goes onto say “A micro-organism tested the world, Bulgaria and our alma mater. Emergency situation means creating new rules – order of self-discipline, of selflessness, of courage, but also of humility, of patience and humanity. I am convinced that united we will manage because we all strongly believe, hope, love and work for a common cause!”

It is not known how long this extraordinary pandemic will last, not just for European medical schools but for the world. A state of emergency in Bulgaria has not been declared since the second world war.

A temporary ban has been placed on citizens of countries such as the UK where the virus is widespread. Only those who hold a long-term residency card will be allowed entry at the moment. All students who will be returning for countries at high risk including the UK will also be required to self-quarantine for 14 days .

Nonetheless, despite this education must go on lecturers/professors who have already begun posting work online so that students who are self-isolating but well enough, can undertake the work. The primary mediums used by universities to do this are online portals, to access this student will need to log in using their specific codes/logins they would have been given by their universities.

What Does This Mean for Students Applying for Oct 2020 Entry?

Currently, there is little information available regarding how the COVID-19 outbreak will affect the admissions cycle for entry in October 2020.

Although there are no delays announced in the timeline as of yet by any of the European medical schools. We do know that universities are planning on conducting the entrance exams online rather than at the university campus or in London.

Those that were due to sit their A-level exams this year should not worry since the government has announced that they will receive the qualifications regardless of the summer exam session being cancelled this year.

Since Bulgarian medical schools such as Plovdiv Medical University only require a pass in the A-level chemistry and biology, the majority of students will still be eligible to sit the entrance exam.

Thinking about studying medicine abroad in Europe this year? Join MedConnect Europe’s live event to speak to current students and graduates!

This is a FREE virtual open day where you will get the chance to learn from current students and graduates about the opportunities available to study medicine or dentistry in Europe for both a 6-year undergraduate and 4-year graduate entry.

Please note – this post was written on the 8th of April and subject to change.

Written by Naomi Adejumo. Edited by Emefa Vondee.

Medical school: how to proceed with your application

Wed, 15 Apr 2020 16:52:05 GMT

With so many changes in the last few weeks – from schools and colleges being closed, the extra strain on the NHS and the uncertainty of when Universities will be opening again – you are probably wondering what COVID-19 means for your upcoming application. Currently, there has been no new guidance for medical or dental applications so we are all still unsure how applications will be managed this year and whether there will be any changes.

However, a good thing to note is that all other applicants are in the same boat as you. Universities know the huge impact that COVID-19 is having on the current year and will most likely take this into consideration when reviewing applications to both Medicine and Dentistry.

So what can you do practically?

1.Volunteer

If you have the capacity, it is a good time to see if you can gain any volunteering opportunities that will aid your community during this uncertain time. There are various opportunities available such as befriending a lonely person via phone or delivering shopping to someone who is unable to get out and about. Search for local opportunities within your borough or within the NHS and see if there is anything that you feel comfortable doing. Not only will this give you a chance to fill your spare time, it is also a chance to gain an understanding of what it would mean to be a key worker during this time!

2.Speak to a healthcare professional

If you are currently not feeling you have the capacity to volunteer – try not to worry. Use your social media to try and reach out to current doctors/dentists or medical/dental students you may know. Ask them if you can have a short conversation about their experiences and try and ask them any questions that are important in understanding life as a healthcare professional as well as why you want to study Medicine or Dentistry. This will give you a chance to gain more understanding of the profession even though you are unable to complete the needed work experience. UCAS are providing opportunity to speak to students on the courses you are planning to apply to and ACMM are always here to help – get in touch with us if you are struggling to find any healthcare professionals to talk to.

3. Keep up to date with the news

It’s important during this time to make sure you are not obsessing over COVID-19 as this can be very detrimental to your mental health. However, try to keep updated with what is happening – specifically learning more about pandemics, viruses and how the healthcare system in the UK is managing. Medical school interviews do test your interest and understanding of current healthcare issues and having a good grasp of knowledge currently will be helpful for your interview in the future as COVID-19 and pandemics could come up!

4. Try and keep a routine

Although you may not be at school or college anymore – it is important to try and keep a routine. Firstly, it will make it easier for you to go back to normal once sixth form and college resume and secondly, it will allow you to feel like your day to day has more purpose. Try to set yourself some goals each day and each week such as reading a new book, exercising or learning something new. During this time, it is normal to have down days but trying to fill your time with some productive activity will help the time go by! There are still opportunities to do some of the things you had planned before – universities are providing “Virtual open days” in order for you to get a chance to see the Universities you are applying to and there are many YouTubers out there providing information on the application process as well as their time as students and qualified professionals! Try to fit at least one productive thing into each day!

We’ve left a few links below for you to use during this time – we’re sure you’ll find them helpful!

We understand that this is a difficult time – don’t be afraid to reach out if you are feeling particularly anxious or down, find more here: https://www.nhs.uk/oneyou/every-mind-matters/

Best of luck!

Useful links:

Chat to students:

https://www.ucas.com/chat-to-students

Virtual open days:

https://www.ucas.com/ucas/events/find/scheme/virtual-and-digital?keywords=

Work experience alternatives:

https://www.themedicportal.com/blog/covid-19-the-best-work-experience-alternatives/?utm_source=THE%20MEDIC%20PORTAL%20NEWSLETTER&utm_medium=Email&utm_campaign=workexpalt&mc_cid=b2d35de144&mc_eid=4a71f8a8f3

5 Things to do from home to support your application:

https://www.themedicportal.com/blog/5-things-to-do-from-home-to-support-your-medicine-application/?utm_source=THE%20MEDIC%20PORTAL%20NEWSLETTER&utm_medium=Email&utm_campaign=homestrength&mc_cid=857bded17b&mc_eid=4a71f8a8f3

Why we need to stop neglecting psychiatry

Mon, 23 Mar 2020 14:58:50 GMT

“Where art pursues abstract thought, shades of grey and profound questions, science seeks factual knowledge, strict order and clear answers”.

Understanding Medicine through a scientific lens is much more straightforward than seeing it through an artistic one.

Scientific explanation has helped us understand how all of the structures within the human body work together as one complex and interconnected whole. However, one domain that we struggle to link up with the rest of the body is the mind.

The mind cannot be dissected with a scientific scalpel in the same way that the physical body can, therefore we struggle to interpret it within our medical framework.

For this reason, particularly in Western biomedical understanding, we often make the mistake of separating the mind from the body. This division has even seeped into practice within our medical system; we can see this when looking at attitudes towards psychiatry in relation to other specialties.

A perfect example of this during my psychiatry placement. The psychiatrist that I was shadowing was called to the Acute Medical Unit to review a patient who had presented with chest pain, on a background of a severe and longstanding eating disorder. We arrived on the ward, and the psychiatrist asked for a brief overview of the patient’s psychiatric history. However, the A&E doctor sharply replied, “I don’t know, isn’t that your job ?” No effort had been made to even briefly assess the mental state of the patient or understand their mental health history. Unfortunately, the psychiatrist later told me that, from her experience, this kind of attitude is not uncommon; she also said that we do not tolerate this sort of negligence when it comes to other specialties.

Although doctors can’t know everything, we do expect most physicians to have some basic understanding of most core systems, even outside of their field of expertise. So why do we accept such a gap in knowledge when it comes to psychiatry?

Some may say that we generally lack insight into how the mind works, and that this lack of understanding leads to our ignorance.

Psychiatry is a speciality that forces us into the complex domain of the arts; it pushes us to face the many shades of grey that exist within Medicine , and many would rather look the other way. However, we’re forced to face up to the fundamental importance of psychiatry when it comes to patients who suffer from functional disorders (otherwise known as medically unexplained conditions).

Dr Suzanne O’Sullivan, in her excellent book ‘It’s All In your Head’, explores the world of functional neurological disorders: these conditions cannot be medically explained, even after every investigation under the sun has been carried out. O’Sullivan tells anecdotal stories of real patients who have experienced debilitating seizures, paralysis and even blindness with no organic cause; the condition is very real, but the problem does not exist in the physical body, it is rooted purely in the mind. However, the stigma surrounding psychiatry, and our inability to understand the intrinsic and powerful link between the mind and the body, leads to such conditions being hugely under-diagnosed, stubbornly rejected and shamefully misunderstood. This leaves patients suffering unnecessarily.

It is vital that we pay attention to the paramount importance of psychiatry in medical practice. From common colds to debilitating functional disorders, each patient’s personality and mental state will always mould their experience of illness in some way. As stated by Dr O’Sullivan,

“If you take one hundred healthy people and subject them to the exact same injury you will get a hundred different responses. That is why medicine is an art.”

And that is why we must give psychiatry the credit it deserves.

Davina Nylander, 5th Year Medical Student, University College London. Edited by Emefa Vondee.

References

O’Sullivan, Suzanne. 2015. It’s All In Your Head. London: Chatto & Windus.

Practising medicine in Australia

Sat, 25 Jan 2020 17:34:08 GMT

“So where have you worked apart from here then?”. This is the question I am asked constantly by new colleagues whenever I start a new clinical post.

My journey began in Newham, East London where I attended Primary school, Secondary school and Sixth Form. I went straight into Undergraduate Medicine in September 2010, attending Keele University Medical School and graduating in July 2015. I did my FY1 in Shrewsbury, and after scoring highly in my NHS E-portfolio, I then transferred deanery to do my FY2 year at the Queen Elizabeth Hospital in Birmingham.

The reason I chose to move to Australia to work for a year was a very simple one; I had never had a ‘break’! Many people decide to do ‘gap years’ before going to University to travel the world or to earn more money, whereas some choose to do that after completing their degree. To apply to work in Australia is easy, but the process is very long and it will cost you roughly £3.5-4k. Fear not, however, as I’m yet to mention that the pay there is double what doctors typically earn in the UK, plus the fact that I was paid fortnightly. So as a Senior House Officer (SHO) over there I made that money back in a month.

The process of applying roughly went as so, I drafted a simple email introducing myself as an FY2 doctor from the UK who was looking to start working in Australia from August 2017 and that I would “love to have the opportunity to apply to your hospital.” I then included my updated CV as an attachment. I sent this to one of the emails and Bcc’d the following 20 or so addresses, this way I applied to 20 different hospitals at the click of a button. By December 2016, the majority had replied to me stating that it was too early for their application process, but a few did contact to arrange either video or telephone interviews. Upon accepting an offer at Brisbane, one of the biggest and most exciting cities in the country, I was sent an application for my VISA and EPIC account (to allow me registration with the Australian Medical Council).

Brisbane is my favourite city in Australia and if I were ever to move there in the future, it would be my unquestionable choice. It resides on the East coast of Australia, and is very central, making it easily accessible from all the other major cities on that side, i.e. Sydney and Melbourne. It’s also South of the Great Barrier Reef. I booked off 2 weeks of annual leave and did a road trip from Brisbane, all the way to Port Douglas and back. In that time, I made stops to kayak in the open water, visit Koorana Crocodile farm, take islands boat tours, snorkel in the Great Barrier Reef, and take a cable car up a rainforest.

In terms of the clinical aspect of being in Australia, working there was very similar to how the NHS is run, aside from the fact that a significant proportion of citizens there have private healthcare. I didn’t have any issues adapting to working somewhere so far away from home, as the drug charts were similar, how they would organise medical notes, and also the management of common conditions. The biggest difference I noted, and which took me a while to get adjusted to was the fact that patients and even clinicians would mention medications by their brand name, as opposed to their generic name, i.e. Panadol instead of Paracetamol. In the UK, the GMC and NMC make it a legal requirement for all medications to be prescribed using their generic name, as to avoid confusion and importantly prescribing errors.

Whenever I look back on the 8 months I spent in Australia it’s always with a smile on my face, whether I’m thinking about the good or the bad – and trust me, there was plenty of both! Thankfully I have a hoard of pictures and videos that will remind me of the many memories I made whilst there, and I have friends there who I am still in contact with. I have since encouraged anyone who has asked me about my time there to make the journey themselves, especially to live/work there for a period of time if at all possible. I am a big advocate for spending time working abroad because aside from providing invaluable experience and developing you as a person and a clinician, it also allows you to think about the differences that country has to your own; the things you appreciate in your society and what you would like to see change.

Dr Andrew James Simon MBChB (Hons)

ST1 Obstetrics & Gynaecology

Edited by Elina Daitey.

When's the right time for a medic to start a family?

Sat, 04 Jan 2020 14:15:55 GMT

I'm Toni, 26 year-old medical student, wife and mum of two.

Before deciding to have my children, I searched the internet for UK medical students who had done the same, all I could find were mature students who had older children prior to medical school. The desire not to let medicine rule my life, led me to follow my heart and start a family. I believe I have a unique perspective in being pregnant during pre-clinical and clinical years, whilst still managing to achieve distinctions each year.

I had my first child at the end of second year, where attending labs and lectures during pregnancy was relatively easy as I had no clinical placements. However, I would often have to sit down due to lack of energy, and would revise at times when I felt less tired and sick. It was nice to feel baby kicks whilst sitting through lessons, like my own little secret reminder and motivation to focus. Second year exams were a struggle as the third trimester is exhausting; it took every ounce of energy to sit down and revise. Eventually, I made a last-minute decision to take a year out, to focus on being a mum. In hindsight, I am glad I did this because it was a hugely beneficial adjustment. Fortunately, my university were very flexible and although I was sad to leave my cohort, I reminded myself that I started the course alone and that this was my personal journey.

“It was nice to feel baby kicks whilst sitting through lessons, like my own little secret reminder and motivation to focus.”

With regards to family planning, I didn’t want a huge age gap, so I decided to have my second child after fourth year. This presented new and different challenges because I was now on the wards daily. This required more concentration, alongside strength to push through severe morning sickness and SPD (symphysis pubis dysfunction). I was taking anti-emetics and wearing anti-sickness wrist bands daily. Despite it being a difficult second pregnancy, whilst raising my toddler, my principles in being organised, planning ahead and working little but often, saw me through my finals. Rather than taking another year out, an alternative option presented itself, the opportunity to do an intercalated masters in Medical Education. This appealed to me because there were only a handful of teaching days throughout the year. It allowed me to mostly work from home, writing essays whilst breastfeeding. On teaching days, I was even able to take my newborn to university with me which was super helpful. I had all of the typical mum issues to deal with: toddler tantrums, sleepless night, a house to run and on top of this the typical student issues: deadlines, procrastination and the dreaded dissertation. However, I survived and even enjoyed the year!

“Despite it being a difficult second pregnancy, whilst raising my toddler, my principles in being organised, planning ahead and working little but often, saw me through my finals.”

I am now in my final year of medical school with a comfortable and efficient routine. The children attend nursery during the day, in the evening we have family time and once they are in bed at 7pm, I usually do an hour of work and then relax with my husband. I often get asked how I manage to fit it all in, but my motto is “work smarter, not harder”, working efficiently can save a lot of time and mastering this early on is key to succeeding in medical school.

Tips for having a baby during medical school:

· Speak to your university in advance to see how they can support you.

· TED stockings and plenty of water to prevent fainting in theatre are a lifesaver!

· If you have a difficult pregnancy seek medical advice early on to ensure you can maximise your efforts during university.

· Be organised- i.e. make your notes regularly, keep up to date. If you leave things to the last minute and have to cram, you may not have the energy closer to exam time.

· Student finance and the NHS bursary give extra funding for parents, especially help with childcare costs, use it!

“I often get asked how I manage to fit it all in, but my motto is “work smarter, not harder”, working efficiently can save a lot of time and mastering this early on is key to succeeding in medical school.”

There is never a right time to start a family and if it is something you know you want to do; I would advise not to put it on hold for the sake of your career. It is definitely possible to do both and to be good at both. Having achieved distinctions throughout medical school, a masters and having loving, intelligent, amazing children, I feel I can now happily progress through my career just like any other doctor and continue to achieve.

Post written by Toni Robinson MA, FHEA, Final year Medical Student at Keele University.

Edited by Elina Daitey, thinktank coordinator.

The great vaccination debate

Sat, 21 Sep 2019 12:04:47 GMT

As I was scrolling through my timeline on Twitter, I came across the shocking case of the unvaccinated French boy may have introduced measles back into Costa Rica whilst there on holiday with his family. What makes it worse is that measles is highly contagious disease, posing great threat to a country which had been free of the disease for 5 years prior to this event taking place. The boy and his parents were kept in isolation within a medical facility in Costa Rica, during which time reports on other children at the boy’s school in France, infected with same virus, also surfaced.

This story alongside the general ongoing debates on infant immunisations, to me, raise an important question. Should parents have a choice when it comes vaccinating their children, considering the devastating impact not vaccinating children could consequently have on other individuals. Conversely, the paper by Andrew Wakefield in 1998 linking the MMR vaccine to autism has since created a lot of sceptical parents, which although understandable, generates a sense of shame and fear through insinuating the general public are still suffering as a result also 2 decades later.

The World Health Organisation have even stated that “vaccine hesitancy- the reluctance or refusal to vaccinate despite the availability of vaccines” is one of the 10 most serious threats to human health, and I’ve got to say I agree. Vaccinations are such a cost-effective method of preventing 2-3 million deaths annually, but their progress can be easily hindered by the lack of people taking them or the lack of access some people have to them. For these reasons there has been a 30% increase in the cases of masles worldwide.

But regardless of my opinions here are some pros and cons of vaccinations for children:

Pros:

- Vaccines can save lives

- The ingredients in vaccines are safe in the amounts used

- Major medical organisations such as the CDC and FDA state that vaccines are safe

- Adverse reactions to vaccines are extremely rare

- Vaccines provide herd immunity

- Vaccines save children and their parents time and money

- Vaccines protect future generations

- Vaccines have eradicated smallpox

Cons:

- Vaccines can cause serious and sometimes fatal side effects ie. A life-threatening allergic reaction

- Vaccines contain harmful ingredients

- The government intervene in personal medical decisions which arguably should be left up to the parents

- Mandatory vaccines infringe upon constitutionally protected religious freedoms

- Vaccines are unnatural, and natural immunity is more effective than vaccination

- Diseases that vaccines target have essentially disappeared

- Most diseases that vaccines target are relatively harmless in many cases, thus making vaccines unnecessary.

Another time to get vaccinations is now approaching – freshers’ week. During this time many students move to new locations and meet a plethora of new people; they can become introduced to new bacteria that their bodies are not used to. A consequence of this could be a term called “Freshers flu”. I had always thought that this condition was made up before experiencing it myself, despite being up to date on all of my vaccinations. If you are reading this article as fresher, and aren’t up to date, my advice is that now might be a good time to look into this.

I believe that it is important that everyone has access to vaccines as prevention is always better and in the long-term cheaper, than cure. It is very important that people are educated about the risks of not getting vaccinated, for not only themselves and their children but also for the wider world.

Article written by Mona-Lisa Fynn

Edited by Elina Daitey

Know your limits

Sun, 16 Jun 2019 17:21:40 GMT

For the longest time I failed to acknowledge that stress was a real thing…

As comical as it may be, I always attributed stress to those cartoon characters who would show their anger or frustration with steam coming out of their ears or visual signs of their temperature rising. I now know differently.

My experience with stress and anxiety was linked to my time in dental school, where academically I found it tough and it affected my confidence in more ways than you can imagine. With that came anxiety and it is only now looking back over my time spent in dental school that I can actually acknowledge and understand that my body was under immense stress. This continued into my first year of work, where I started feeling like a fraud in my own job, mentally convincing myself that I had no right to be there.

My inability to focus on tasks, generalized anxiety, lethargy and even episodes of hair loss were key indicators that my body was struggling to keep up with the crazy demands I was putting on myself as a student... I was burning out, big time, and I was failing to recognize the signs.

Studies have shown that dentists have some of the highest suicide rates of any profession in the world. The constant patient demands, the challenges of being self-employed and maintaining a stable income as well as fears of litigation are just some of the few contributors to stress for dentists.

If we are honest with ourselves, as medical professionals, we are often not willing to accept that even the best of us go through stressful periods of life where we’re at our wits’ end – whether that be as a student or in our careers. Failure to acknowledge this is only a disservice to ourselves. The first step to bring you back to normality is acknowledging that you are struggling, and then from there, making the necessary choices to eradicate the stressful factors hindering your optimal functioning.
For the sake of practicality here a few things that have helped me thus far with managing stress, that possibly might help you too:

1. Listen to your body:

I now recognize and acknowledge when my body is under stress, or when I’m feeling anxiety. I learnt the hard way, but you don’t have to. Stress will affect people in different ways. Being in tune with how you’re feeling can be the key to preventing further stress and anxiety before can begin to ruin you.

2. Saying no is ok:

‘No’ is a valid answer. You don’t have to say yes to every event, conference or speaking engagement if you know you’re going to end up running on empty fuel as a result of your energy being drained.

3. Prioritise:

If you have a task to complete that you can get done now, then do it now. Don’t put off to tomorrow what you can do today. And if not, then learn to prioritize your tasks by levels of importance.

4. Talk:

We spend so much time listening to our patients but who listens to us? Don’t struggle alone. Talk to God, a friend or family member, even a therapist if you must. Express to them how you’re feeling. You’d be surprise how a problem shared is a problem halved.

5. Switch off:

Learn to put your work away when you leave at the end of the day. Don’t mull over all the things you could or should have done throughout the day. Try not to take work home with you; there should be a healthy distinction between work and relaxation.

The pressures we face as millennials can be ever increasing and although this piece is targeted at medics and dentists, I’d like to think that the above are practical steps that anyone can take to combat the effects of stress.

So, if you find yourself or someone you know and love in an incredibly stressful period of their life, give them an opportunity to get things off their chest, and if you remember nothing else from this, remember this:

Article written by Dr Ruth Baidoo Bsc ( Hons), BDS, MJDF RCS ( Eng)

Edited by Elina Daitey