Article Responses: May 2002

Articles	Responses
EDITORIALS The changing legal landscape of discrimination in medicine Peter Taysum (June 2002) [full text...]	Tarek S Arab (June 2, 2002) Read this response

NEWS GMC wins right to discriminate against disabled student Anna Ellis (June 2002) [full text...]	Renee Sewell (May 27, 2002) Read this response

LETTERS Different rules for dressing appropriately Zain Kapasi (May 2002) [full text...]	Tom Fletcher (May 26, 2002) Read this response Nandita K Parmar (May 22, 2002) Read this response

LETTERS Budget does not consider whole NHS picture Holly Thomas (June 2002) [full text...]	Paula Boughey (May 26, 2002) Read this response

LIFE Telling strangers not to shave: not everyone speaks English Layla McCay (June 2002) [full text...]	Sakura Hosoda (May 23, 2002) Read this response

LETTERS Abortion: a question of gut feeling Sharon Barclay (May 2002) [full text...]	Neda Montazeri (May 23, 2002) Read this response Andrew Tindall (May 2, 2002) Read this response

EDITORIAL Global arguments: breaking the borders for medicine Navin Chohan (May 2002) [full text...]	Jacco Veldhuyzen (May 14, 2002) Read this response

REVIEWS Körperwelten: the fascination of authenticity Dora Vertes (May 2002) [full text...]	Nigel Lane (May 2, 2002) Read this response Celia Parkyn (May 2, 2002) Read this response

	EDITORIALS The changing legal landscape of discrimination in medicine Peter Taysum (June 2002) [full text...]
	Tarek S Arab (May 31, 2002) King AbdulAziz University medical school, Jeddah, KSA captflashheart@yahoo.com
	I was saddened by the news that the GMC, out of sheer minded hypocrisy decided to throw a major obstacle in the path of a potential doctor, on the basis of their being disabled. I find it comical that whilst the GMC makes no effort to put in place legislation ensuring that only those of sound mind are permitted to enter the profession, they have no qualms about discriminating against those who are less than able bodied. The GMC over the last 10 years has proved that it is out of date, out of touch and incapable of regulating the profession. Scandal after scandal has eroded the trust of the British public in doctors in general and it has been the unwillingness of the GMC to properly execute its responsibilities that I believe contributed to the Harold Shipman case and the Bristol scandal, amongst others. Why have they not put into place safeguards to prevent such scandals, when in the past the number of sensational cases of medical negligence have been too numerous to count? The fact that structured training was only introduced 5 years ago in most specialities when it has been a feature of medicine in North America since the late 1920's, the fact that there seems to be no way that a doctor can report medical negligence without repercussion, the fact that the revolutions in medical education only took place in the last 10 years when the GMC has been in existence for much longer than that and the fact that the GMC has done NOTHING to try to prevent the kind of racial discrimination that is rife in British medicine points to only one conclusion that the GMC needs either radical reform, or should be removed from the playing field, replaced with another regulatory body that can actually discharge its responsibilities. In today's world more than ever, we as doctors and medical students need to feel secure that our profession, our rights are being safeguarded and administered by those capable of adapting to the modern world, at the same time as the rest of the world, that safeguards are being put into place before as opposed to after public and governmental pressure are brought to bear, and that their is no discrimination based on race, colour, religion or " disability". The GMC has just shown us all by this last action that they are not the regulating body that we need. If in the next 10 years the government decides that we as doctors can no longer be trusted to regulate ourselves and imposes on us a regulatory body composed of non- doctors, then we can thank the GMC. What does it say about the humanity of doctors when they cannot even take care of their own?

	NEWS GMC wins right to discriminate against disabled student Author (May 2002) [full text...]
	Renee Sewell (May 27, 2002) Barts and the London london_luvly@yahoo.com
	I think the situation faced by this determined young woman is awful - if physical ability is to stop her from becoming a doctor where do we draw the line - mental illness can be left undetected for years in doctors; Shipman is a testament to that! It is incredibly myopic to say that there is no field of medicine in which she would be found competent to practice and any of us can be injured or diabled at any time- is that to say i will loose my livelyhood and career in one fell swoop. There should have been more thought and consideration about the implications of this ruling.

	LETTERS Different rules for dressing appropriately Zain Kapasi (June 2002) [full text...]
	Tom Fletcher (May 26, 2002) Leeds University ugm8tef@leeds.ac.uk
	At last, Zain Kaposi in his letter hinted at what myself and many colleagues have thought a while: The discrepancy between what male and female medical students have to wear. All males understaned the shirt, tie and trousers rule and uniformly follow it. Maybe the more rebellious amongst us undo a top bottom or 'heaven forbid' discard the tie, ever weary of the potential 'rollocking' that may come. However, there doesn't appear to be any guidance regarding women's dress. Many say that it is not as easy for them to look smart, but surely there is no case the strappy top, t-shirt or vest that seem ever more popular. Only once have I heard of a female student being told to 'smarten up'and that was by a female consultant. Do the others simply fail to notice, just appreciate what is often on display or fear the consequences of saying anything? Maybe a uniform or some recommendations are the answer. On the continent many doctors change into white scrubs when they arrive at work. Smart,clean and comfortable. In these days of infection control most doctors now wash their hands in between patients. But how often does that draping favourite tie get washed I wonder? Take this example. A general surgeon looking very smart in his expensive suit starts his afternoon clinic. 20 patients and 10 PR's later he sets off home to eat dinner and play with his children in the same clothes. Pleasent or necessary...I don't think so!
	Nandita K Parmar (May 22, 2002) St. George's Hospital Medical School sgms617@sghms.ac.uk
	I read Zain Kapasi's letter (1) on dressing appropriately with great interest and although I agree with his view when he says that it makes no difference to how he treats a patient, it should be pointed out that it indeed does make a difference in the way the patient perceives a doctor. -The first issue is about white coats which are worn by both doctors and doctors-to-be. The recognition, symbolism and formalism offered by a white coat has been shown to enhance the communication and facilitate the doctor-patient relationship (2). In addition, personnel in white coats seem more hygienic, professional, scientific, competent, knowledgeable and approachable. The practice, however, is declining and the only two major groups who still wear them include consultants and students.White coats are important for recognition by colleagues and patients, to place items in the pockets and keep clothes clean. In paediatrics and psychiatry, the converse is true as children and patients regard formally dressed doctors as competent but not friendly and vice versa in casual dress. -The second issue is that of different dressing rules applying for male and female doctors/students. Although females have a wider variety of choice in clothing attire to wear, what they do wear has to be practical .It was recently when I went shopping for a suit to wear for my clinical finals that I realised the dilemma. It may be silly to point out that storage space/pockets do matter when one has to for example take the minimum of a stethoscope, pens, torch, red-hat pin and tape measure for the finals.Male students are at an obvoius advantage here. -The points that have been raised should hopefully make the readers aware that both female and male students have problems in choice, albeit in different ways, but it should be clear that what they wear is practical, presentable and professional -with or without the white coat! References Kapasi.Z. Different rules for dressing appropriately.s-BMJ May 2002:164 McKinstry B, Wang JX Putting on the style: what patients think of the way their doctor dresses .Br J Gen Pract 1991 Jul;41(348):270, 275-8

	LETTERS Budget does not consider whole NHS picture Holly Thomas (June 2002) [full text...]
	Paula Boughey (May 26, 2002) University of Manchester pboughey@hotmail.com
	I was disturbed to read the views of Holly Thomas on the recent budget (star letter- budget does not consider whole picture. Student BMJ June 2002). While most medical students would welcome an NHS bursary and payment of our tuition fees by the NHS with open arms, the reason why this funding is given to nurses but not medical students seems obvious. Getting a place at medical school is not an easy task, with 10,972 applicants for the 5454 places available in 2000,1 there are many wanting to go into the profession. Nurses however are in shortage. Few want to go into a de-moralized profession in which long hours are the norm, for little reward. Student nurses halved in number between 1985 and 1995 2, and with one in five nurses over fifty, the profession stands to lose a large bulk of it's workers through retirement in future years,3 so it is no surprise that the government are desperate to recruit more. The way this is done is by means tested bursary and paid tuition fees. That is not to say that student nurses are loaded! Far from it, the means tested bursary frequently leaves students with a "bursary of nil", and the red tape in place then leaves a student nurse with only £1500 of reduced loan to last the year (due to the non-existent bursary). Does Miss Thomas resent this kind of support for nurses? I was given the firm impression that she thought that nurses were little more than glorified health-care assistants, despite the huge differences in training, qualifications, and input into patient management. I agree with the comments that NHS reform should encompass every aspect of patient care, and I believe that the recent pay rise for PRHO's, increased effort to recruit nurses, and more opportunity for health-care assistants to gain further qualifications are trying to do just that. Without incentives for nurses to train, our wards will soon feel the strain. I'm sure that a severe lack of nurses would certainly not be a vote winner, but is improving conditions for nurses merely playing on public sympathies? I hope not. UCAS 2000 Buchan J. The 'greying' of the UK nursing workforce: implications for employment policy and practice. Department of Health 1996.

	LIFE Telling strangers not to shave: not everyone speaks English Layla McCay (June 2002) [full text...]
	Sakura Hosoda (May 23, 2002) Sapporo Medical University; school of medicine sakura1980@beach.ocn.ne.jp
	It seems very hard even at my point of view for native English-speakers to study medicne in Japanese hospitals. As is described by Dr.Layla McCay, there are hardly any English sings even in university hospitals, especailly in old hospitals.I think it is partly because those hospitals which have no signs or marks written in English were built without keeping it in mind that foreigners(both patients and doctors) would come. Recently more and more foreign doctors and patients become to come to Japanese hospitals respectively in order to study medicine or undergo medical treatment.So some hospitals have been making arrangements so that foreign people who don't understand Japanese language can take advantage of Japanese hospitals more easily and effecitively. Yet most Japanese hospitals are hard to use for foreingners. Another imaginable reason of difficuly in studying medicine in Japan will be the fact that basically Japanese students and doctors are not very good at speaking Japanese. Japanese medical students and doctors can read and write English very well, so most of them read medical papers written in English with little difficulty.But when it comes to English conversation, they have a lot of difficulty. Maybe this truth will be famous all over the world, I think.(While I am now writing this letter, I sometimes use a dictionary!) It is true that many doctors in university hosipitals have been abroad for medical study and that they can speak English to some extent, but they don't seem to be willing to communicate in English in Japanese hospitals(partly because they've not got enough time to traslate everything they have said.). In fact, there are not as many foreign doctors as in Japan as in European and American unis. There are many Japanese medical students who want to go abroad for study in the future and I am also one of them. The other day, I heard of a Japanese doctor who went to America for a few years from my parents(my parents are both doctors and friends of his.) The next was said by him; " If you cannot speak and understand English, there is no point in going abroad, and furthermore the doctors there won't correspond to you and only neglect you! So if you really want to study abroad in the future, you should improve your English coversation ability now as you are students. Once you graduate from uni, you will not be able to spare time for it." Thus, the language problem is more serious than is expected, particularly, when a doctor go to a country where a language he or she do not understand. Truly I am glad some people are interested in Japan and its culture and chose this country to do elective or medical study, but do not think the difference of languages matter little, it might be a cause of tragedy. If one native English speaker wants to study medicine in a foreign country,especially in a country where English is not legible, he or she should make sure to be prepared enough for it (If it is impossible,it may be better to give it up). Now that English is thought of as international official language all over the world, BUT countries such as Japan have not yet caught up with the INTERNATIONALISARION OF LANGUAGE!! Keep it in mind.

	LETTERS Abortion: a question of gut feeling Sharon Barclay (May 2002) [full text...]
	Neda Montazeri (May 23, 2002) Liverpool university nmontazeri@hotmail.com
	I agree with the comments of Sharon Barclay who stated that abortion is and always will be a controversial subject. But I do think it is more than just a question of gut feeling. Most people would have an opinion on abortion based on their personal experiences, moral or religous views. We also have to accept the possibility that these may change when actually faced with such a situation. It is very important as doctors to respect patients' views and their autonomy and allow them to make their own decisions. At the same time, I am sure many people would agree that abortion should not be allowed to become a contraceptive option and should be reserved for genuine reasons why a pregnancy should not be continued.
	Andrew Tindall (May 2, 2002) Southampton general Hospital APTINDALL@aol.com
	Sharon Barclay complains at Abigail Howgegos 'gut feeling' about abortion, giving the impression she complains about some type of bias. We are all biased either one way or another. For example, Ms Barclay does not complain about the original pro abortion article, leaving me to assume she is biased in favour of abortion. Ms Barclay states 'As doctors, however, our thoughts must come second to the welfare of our patients.' Was she not in class the day she was supposed to learn about the formation of the embryo and feotus? Does she not realise the detailed complexity of the unborn within a few weeks of conception? Does she not agree that the child developing within the womb is surely a 'second patient'? The argument often goes that the 'second patient is not fully formed or functional. Well neither is the newborn, but I'm sure she does not agree with infantcide. Ms Barclay also states 'Abortion is a necessary evil in our society: an undesirable yet unavoidable solution to unwanted pregnancy.' I am so grateful that my natural mother did not see abortion as an unavoidable solution to conceiving me and instead placed me in the care of an adoption agency who found most loving and caring parents to bring me up. Maybe some people think I should have been snuffed out in the womb?

	EDITORIALS Global arguments: breaking the borders for medicine Navin Chohan (May 2002) [full text...]
	Jacco Veldhuyzen (May 14, 2002) Vrije Universiteit Medical Centre, Amsterdam, the Netherlands jacco@veldhuyzen.net
	I was very pleased to see that studentBMJ devoted an editorial to the International Federation of Medical Student Associations in its last issue. Being active in IFMSA for several years myself, I really appreciated the critical view on IFMSA. To a large extend I agree with the views expressed in the article, but I would like to point out two points which I believe to be incorrect. In your editorial you conclude that IFMSA is an organisation run from then top-down. This is not entirely true. As you said, in IFMSA the people at the roots are the ones who make things happen. That is a very important point and it is reflected in the autonomy of the member organisations. They choose their activities and the way to organise them. The Executive Board manages the international network and the communication channels between members, but that's where the responsibility ends. It has nothing to say about the way member organisations run their business, leaving the initiative for activities and the power at the place where it should be: the roots. At the end of your article you conclude that politics and bureaucracy kill good projects. There is indeed some bureaucracy and politics in IFMSA, but we always try to prevent this getting in the way of our activities. We continuously try to find ways to make organising activities easier. Besides which, there are more damaging factors then bureaucracy and politics that could slow down or "kill" projects. Over the years we have created several training programmes and support mechanisms for projects. This all with the aim of preventing them from failing due to a lack of funding, lack of experience, or the lack of manpower. Only through these activities can IFMSA achieve its objectives. At first glance IFMSA might seem like just another paper tiger with a lot of regulations and byelaws. But below that surface there are thousands of activities, all created, managed and executed at the local level, at medical schools all over the world for and by medical students. The best way to experience that is by joining IFMSA. Then you might see for yourself that IFMSA is able to convert talking and politics into action. Into the local activities that are achieving so much all over the world. We do have the power to change. Jacco Veldhuyzen, Medical Student, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands and Treasurer, Executive Board, IFMSA

	REVIEWS Körperwelten: the fascination of authenticity Dora Vertes (May 2002) [full text...]
	Nigel Lane (May 2, 2002) University of Bristol nige_lane@hotmail.com
	I feel that Dora Vertes criticism of Professor Gunther von Hagen's exhibition is harsh and unfounded. While we are taught to have utmost respect for the body, it is only natural that the general public will have a fascination and want to see what is 'inside themselves'. Why should this desire for knowledge be reserved for medical students? Miss Vertes points out that the people had once loved, lived and died. This is true but my understanding is that they had decided to take part in this project while they were still living. They were not forced into it. I do not see the problem with freedom of choice surrounding what happens to your body after death. People plan their funerals in advance of death, is this so different? Why should we accept that our bodies will be buried and decompose or be burned? The public who came to see the exhibition are no different from her and it is foolish to suggest that future doctors are able to show greater respect for death than them. Miss Vertes also points out that the bodies are modelled into poses reminding her of sculptures and paintings. Is this so wrong? Indeed the people views Leonardo da Vinci's drawings of dissections, as they are technically accurate and beautiful. No one would dream of ascribing words such as "disguised horror" to them. Professor Gunther von Hagen has painstakingly worked to produce the next generation of anatomical art which rightly interests, excites and educates us. The exhibition challenges the viewer to consider the amazing adaptability and movement of the human body in life. What information could be provided to people by showing corpses lying still on their backs? No lines have been crossed, no mistakes have been made, and I look forward to visiting the exhibition after my Finals this summer.
	Celia Parkyn (May 2, 2002) University College London c.parkyn@ucl.ac.uk
	I was disappointed by the opinion piece written about Prof Gunther von Hagen's work. I found the article patronising and self-righteous. The author seems to think that the only people who should be allowed to see inside the human body are medics and that any one else interested in the human body must be perverse. I have a number of comments I would like to make in defence of radical exhibitions such as Bodyworks. (i) If von Hagen presented the bodies in a traditional fashion then the exhibition would have only appealed to a limited audience. As it stands, the accessibility of the bodies has allowed a very different type of person to see what bodies can look like, and in a way, learn more about themselves. (ii) Learning by parrot fashion has been long outdated, and any primary/ secondary school teacher could tell you kids remember things if they find lessons interesting. For all those who have visited the exhibition, it will be hard to forget the spinal sclerosis or enlarged hearts. Just because the exhibition has wide appeal is no reason to criticise the content. Not only was Bodyworks interesting, but it was informative as well. (iii) The author seemed to think that the entire exhibition was produced to make money. The same could be said of anyone who works - they only do the job because they get paid, even doctors. The author perhaps has overlooked the huge costs imposed on such a exhibition travelling the world. Such costs include hiring gallery space, packing and transport and publicity. Also, if the exhibition was put to make money, why was there a two week period when anyone under 18 could view the exhibition for free? (iv) Medical students are suppose to think of both cadavers and patients as people with thoughts and feelings, but how often do they forget about the patient, and only think of the illness? And, how many are guilty of examining a patient under general anaesthetic with out consent? All the people who had donated their bodies for the works had at least given permission, even if they were dead. I would rather my body be preserved by plastination with my permission than having some medical student give me a rectal examination without consent while I was under general anaesthetic. Modern society boasts of being open minded, but when it comes to the medical profession, many seem to remind backward thinking and prejudice of new ways to view the body. Pioneering new medical or surgical techniques are always first to be criticise if the media finds them inhumane or unethical. Medical students are taught to be non-judgemental, so why has the Student BMJ published such a conservative and out-dated opinion piece? Surely most current medical students would view Bodyworks as a celebration of how fascinating and amazing the human body is, not some immoral way of making money? See www.bodyworld.com for more information about von Hagen's work.