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Indian doctors call off strike

Doctors at leading Indian hospitals called off a three week old strike against a government plan to reserve more college places for lower caste students, after the Supreme Court told them to resume their duties to ease patients' suffering.

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The strike has crippled services at many state run hospitals throughout India. Medical students were also involved in the campaign, which became violent in New Delhi and Mumbai, where police caned doctors.

The protest began soon after the government announced in April that it would more than double the number of places in state funded colleges allocated to people of lower castes. The demonstrators said this would make it harder for upper caste students competing on merit to get places at federally funded medical, management, and engineering colleges and universities.

The court told the protestors that it would not stand for inconvenience to the general public, but it also asked the government to explain why it wanted to introduce the controversial policy, and said doctors would be protected from any government sacking orders if they returned to work.

University admission criteria for lower-caste students are less stringent than for those competing on merit. The government says lower castes have traditionally had poorer access to quality education and need help from the state to get into India's top institutes. Though caste discrimination is outlawed in India, the ancient Hindu social system still affects the lives of millions of people and can lead to tension and violence in rural areas.

Some doctors and medical students had gone on hunger strikes. Others refused to work in hospitals and instead saw patients in makeshift camps. One protestor, reported to be a medical student, tried to set himself on fire before being taken to hospital in a police van for treatment for his burns.

The prime minister, Manmohan Singh, promised massive expansion in higher education to create more places overall and not just for people of lower castes in an effort to placate the protestors.

In the meantime, some patients had to wait 20 days to see a doctor until the strike ended (www.reuters.com).

German doctors protest at working conditions

Long hours and low pay have brought German doctors on to the street in force in the past few months. More than 12 000 university and state hospital employees in nine German states have protested against working conditions they see as far inferior to those of their colleagues in the rest of Europe, with high profile strikes affecting about 40 hospitals.

“The working conditions at the clinics are getting worse and worse,” said Athanasios Drougias of doctor's trade union Marburger Bund, which has nearly 105 000 members. The head of that union, Frank Ulrich, recently told German radio that a third of doctors were now seeking work outside the country, many of them heading to the United States or the United Kingdom.

Doctors' leaders say that German clinicians are underpaid relative to their European counterparts. Moving abroad to work could double or even triple their pay.

The departure of young doctors has started to take its toll on the already flagging hospital system, and has contributed to a list of 3000 unfilled positions, according to one doctors' organisation.

Although the government's proposals for healthcare reforms to address the problem have stalled amid political bickering, the migration shows no sign of stopping, and those doctors who do not leave the country are looking at other options, such as medical journalism or jobs at pharmaceutical or consulting companies (www.csmonitor.com).

Can Mozart make you see better?

Listening to Mozart has already been associated with improved performance in maths, enhanced fetal brain development, and better learning in college students. Now Brazilian researchers have found that the “Mozart effect” improves performance in a visual field test.

Researchers from Sao Paulo found that automated perimetry results were better in a study group who had listened to 10 minutes of Mozart's sonata for two pianos before the test than in a group that had prepared for 10 minutes in silence.

Writing in the British Journal of Ophthalmology, the researchers said that there was already evidence that the Mozart effect improved spatial-temporal reasoning. “We could assume that listening to Mozart can either ‘prime' the pathways responsible for visual images, possibly shape or colour or improve intention to some extent,” said author Vanessa Macedo (news.bbc.co.uk).

US faces shortage of doctors

Medical schools in the United States are being urged to increase enrolment, while politicians are asked to make more money available to fund training and to make it easier for foreign doctors to get work, as a looming shortage threatens to limit access to doctors.

Twelve US states either report some shortages or expect them soon. Patients are already or will soon start experiencing a tighter supply of specialists in areas including cardiology, radiology, and some surgical subspecialties.

Intake to medical school has hardly changed in the last quarter of a century, because the schools limited enrolment to avoid oversupplying the market. Now a rising population and medical advances broadening the possibilities for intervention have increased the need. The demands of the post-1945 “baby boomers” will also stretch the system as they approach old age in the next one to two decades.

Yet a third of America's three quarters of a million postresidency doctors are older than 55 and likely to retire just as the demand grows. In addition, younger doctors are less inclined to work long hours, and one researcher expects the workforce to be 10% less productive as a result.

Even if medical schools increased student places by 30%, there would still be a greater ratio of patients to doctors by 2025, according to the president of the Association of American Medical Colleges (www.latimes.com).

Music and medicine course touches a new note

The University of Sydney in Australia hopes to give some of its medical students a good grounding in the human condition by schooling them first in music, through a new course combining the two subjects. Medical experts say the two disciplines combine well, with both requiring fine motor skills, cognitive abilities, and good memory.

Merrilyn Walton, associate professor of ethical practice at the university's medicine faculty, said combining the subjects would bring benefits for the students. “With this programme we are saying that we want them to expand on their creativity and bring it all into medicine because we think they will make better doctors,” she said.

The course, to be launched next year, will have students complete a bachelor of music degree and then a graduate entry bachelor of medicine and bachelor of surgery (MBBS) qualification. Unlike the university's other graduate medicine places, which students usually apply for after completing a first degree, the music-medicine students will be guaranteed an MBBS place if they keep their marks high enough (www.smh.com.au).

PHOTOS.COM

GPs protest at UK plan to rate surgeries

Plans to grade GPs' surgeries into one of three categories to improve standards and make them more “customer focused” have run aground after opposition from doctors.

Britain's Royal College of General Practitioners said that it was suspending talks on the scheme with the Department of Health after complaints from its members.

Ministers want to increase pressure on GPs to show patients that they are getting value for money out of huge pay rises for family doctors. Salary rises last year took the average annual pay for GPs to £94 000 (a140 000; $170 000; www.timesonline.co.uk).

British doctors experiment with altitude

A team of UK doctors will scale Mount Everest to study the effects of high altitude on human physiology next year. Thirty researchers will monitor some 210 people trekking to Everest base camp during the three month expedition, while 10 will climb to the mountain's peak.

“Our Everest ascent will involve creating the world's highest medical laboratory, taking field science to a new level,” said Hugh Montgomery of University College London. High altitudes stretch the body's ability to get adequate oxygen, and Dr Montgomery said that the research could help understand hypoxic physiology closer to sea level. “In our line of work, we all work in intensive care units and all our patients have that problem,” he said. “Some survive and some don't… If we could crack why that is we could make a big difference to all those people” (www.reuters.co.uk).

UK interest in GP jobs remains low

A survey of UK doctors qualifying in 2002 showed that career choices for general practice remained low, at 28.1% of women and 14.5% of men.

In a report in the journal Medical Education, researchers wrote that their results showed no evidence of any increase in interest in general practice as a career choice in recently qualified doctors. The survey was sent out in 2003.

However, the researchers found that only a fifth of respondents were uncertain about their intention to practise in the UK, the lowest proportion recorded in a series of similar surveys since 1996 (www.blackwellpublishing.com).

studentBMJ 2006;14:265-308 July ISSN 0966-6494