Newsbites

Sweden

Medical school expels murderer

Sweden’s Karolinska Institute has expelled a convicted murderer from its medical course on a technical issue, but in doing so has not resolved the question of whether killers can later study to become doctors, the institute’s president said.

Karl Svensson, aged 31, was admitted last year to the prestigious institute, which chooses the winners of the Nobel prize in medicine. But after anonymous tip-offs, the institute learnt that in 2000, Mr Svensson, then using the name Hampus Hellekant, had been convicted of shooting a trade union worker. Mr Svensson maintained that he did not commit the killing and was released last year after serving six and a half years of an 11 year sentence.

A number of doctors, writing in a journal published by the Swedish Medical Association, had argued that Mr Svensson should not be allowed to become a doctor, and the Swedish licensing body had said it would not grant him a medical licence on account of the conviction.

The Karolinska Institute eventually expelled Svensson after it could not check the high school diploma he had submitted. Because the expulsion did not resolve how to handle any future such cases, Sweden must still determine whether medical schools can admit a convicted murderer, said Harriet Wallberg-Henriksson, the institute’s president. News agencies reported that they were not able to contact Mr Svensson (www.newyorktimes.com).

China

Medical schools lure Indian students

Thousands of Indian students are choosing to study medicine in China, where costs are lower and the admission process is simpler, officials have said.

Jasminder Kasturia, first secretary of the Indian Embassy to China, said that the number of Indian medical students in China had risen sharply in recent years. “There are more than 6000 Indian students studying in China now, mainly for medical science,” he said.

Chinese medical tuition fees are $2000-3000 (£1000-1500; €1400-2100) a year, with about another $1000 needed for food and accommodation, which is only one fourth of that in India, the China Daily newspaper said. “This is much more affordable. In India, all the places are taken up even before the exams, so even though we study hard we can’t get a place over there,” it quoted Manpreet Kaur, a second year medical student at Tianjin Medical University, as saying.

Tianjin Medical University has more than 400 Indian students studying for bachelors degrees in medicine, and the number of applicants from India far exceeds the university’s available places, said Guo Fenglin, director of the university’s international exchange department.

The Indian paper The Hindu reported that since 2004 more than 20 Chinese universities had begun to aggressively recruit students from India (www.chinadaily.com.cn).

Canada

Shorter medical training suggested

Shaving a year from Canada’s traditional four year medical degree could be a way to speed up doctors’ training and get them into the healthcare system faster, an editorial in Canada’s leading medical journal argues. Most Canadian medical schools already require students to have completed a four year undergraduate degree before they start medical education.

The article, in CMAJ (2008 Jan 1; doi: 10.1503/cmaj.071726), comes as the body representing the country’s 17 medical schools is starting a review of medical education. The review will consider, among other things, whether to shorten medical programmes to three years and whether to admit students into medical studies without undergraduate degrees.

The University of Calgary and McMaster University already offer three year medical programmes. “There has been no uproar to suggest the three year programs are inferior,” said Paul Hebert, the journal’s editor in chief.

He stressed that the editorial did not advocate a three year programme, but simply wished to encourage debate. The editorial estimated that the extra year of training costs Canadian taxpayers about $170 000 a student (www.nationalpost.com).

Israel

Intimate examinations without consent

Students may have been told to carry out gynaecological examinations under anaesthesia without explicit permission from patients. Israel’s health ministry has ordered an investigation into medical students’ performance of physical examinations in operating theatres after the newspaper Yediot Aharonot reported that 14 medical students had complained to the ministry in recent weeks. But the associate director general of the ministry, Boaz Lev, said this was not true.

The Jerusalem Post newspaper reported that neither Dr Lev nor the deans of Israel’s four medical schools nor the heads of any hospitals it contacted knew of any case in which women had been examined under anaesthesia by medical students for teaching purposes without explicit consent.

A 2005 health ministry directive states that patients must be informed that they have the right to refuse the presence or involvement of medical students in examinations and that when students are involved they must be presented and their status identified to the patient (www.jpost.com).

United Kingdom

One in three doctors attacked

One in 10 doctors in the United Kingdom has been physically attacked while working in the past year, a BMA survey has found. When verbal attacks were counted together with physical assaults, the figure rose to one in three.

In more than half the cases, the doctor involved took no action after experiencing a violent incident, the survey found. “These are worrying figures, both in terms of the potential numbers involved and the fact that so few doctors tend to report violence,” said Hamish Meldrum, the BMA’s chairman.

Attacks were common when patients were frustrated with waiting times or when doctors refused to prescribe drugs or admit a patient. Junior doctors were the most likely to experience violence, followed by GPs (www.guardian.co.uk).

United States

Exploiting the placebo effect

Almost half of internal medicine doctors who responded to a US survey said that they had prescribed a placebo in clinical practice.

“It illustrates that doctors believe expectation and belief have therapeutic potential,” Rachel Sherman, a medical student at the University of Chicago who co-wrote the study, told Reuters news agency. But she added that using placebos raised ethical questions of consent, especially because patients needed to believe in a placebo for it to work.

Of respondents who reported using a placebo in clinical practice, about one third said that they told the patients the substance was something that “may help and will not hurt.” Another third gave other information including, “This may help you, but I am not sure how it works.”

Nineteen per cent said that it was a “medication,” and 9% called it “a medicine with no specific effect.” Only 4% of the doctors said, “It is a placebo.”

The study, which included the responses of 231 of 466 internists who were sent a questionnaire, was published in the Journal of General Internal Medicine (2008;23:7-10; www.reuters.com).

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

   

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