Article Responses: October 2002

Articles	Responses
LIFE Medical students and their faith - being a Hindu medic Sumita kini (October 2002) [full text...]	Dr S P Prabhu (September 27, 2002) Read this response Saroo Sharma (October 15 2002) Read this response Wasiq (October 16 2002) Read this response

LIFE Never say the "Q" word Patric Davies & Adam Fox (October 2002) [full text...]	Dr S P Prabhu (September 27, 2002) Read this response

LETTERS Keeping the important issues in proportion Davina Sharma (October 2002) [full text...]	Sameer Trikha (October 01 2002) Read this response Stephen Goldie (October 07 2002) Read this response

LIFE Medical students and their faith - being a Muslim medic Samena Chaudhry (October 2002) [full text...]	Farrukh Malik (October 05 2002) Read this response Zarin Siddiqui (October 17 2002) Read this response

REVIEWS Medical students should not be forced to study all subjects Kallur Suresh (September 2002) [full text...]	Hereward Hall (October 10 2002) Read this response

EDUCATION ABC of sexual health: Assessing and managing male sexual problems Alain Gregoire (September 1999) [full text...]	Isis (October 10 2002) Read this response

LETTERS Students should learn more than they need to know David Selvan (October 2002) [full text...]	Guy Melrose (October 10 2002) Read this response

LIFE Medical students and there faith - all articles by Zoe Apple, Suminta Kini, Samena Chaudhry and Helen Barratt (October 2002) [full text...]	Fiha Jones (October 10 2002) Read this response Fiona Moreton (October 15 2002) Read this response

LIFE Medical students and there faith - being a Christian medic by Helen Barratt (October 2002) [full text...]	Ross Carruthers (October 11 2002) Read this response Jude Reid (October 11 2002) Read this response

EDITORIALS Child labour Thomas J Scanlon and colleagues (October 2002) [full text...]	Chibuzo C Odigwe (October 11 2002) Read this response

LIFE Medical students and their faith - being a Jewish medic Zoe Apple (October 2002) [full text...]	Saul Kaufman (October 15 2002) Read this response

EDUCATION ABC of oral health: Mouth ulcers and other causes of orofacial soreness and pain Crispian Scully and Rosemary Shotts (October 2002) [full text...]	John Fuhring (October 15 2002) Read this response

LIFE
Medical students and their faith - being a Hindu medic
Sumita kini (October 2002) [full text...]

Dr S P Prabhu (October 01, 2002)
Specialist Registrar in radiology Bristol Royal Infirmary drsanjuuk@yahoo.co.uk

Medical students and their faith - being a Hindu medic - Sumita kini letter: I would like to congratulate the author for an excellent article. Having joined as a medical student 12 years back , even at this stage, I can identify with every one of the author's observations. I think that I am a workaholic and have that extra helping of compassion for patients which I believe is because of my culture and upbringing.

However, it stills annoys me when I see young people squandering their lives away on drugs, alcohol and crime. It is my cultural belief that it is within their power to change their lives and would do so with more family support rather than a social worker or rehab counsellor. But as a medic the appropriate route would be the "official routes to help" and therefore the social worker is the person I would refer a patient rather than a parent for a young person. It is a conflict between my personal and professional belief- what is your view?

LIFE
Medical students and their faith - being a Hindu medic
Sumita kini (October 2002) [full text...]

Saroo Sharma (October 15, 2002)
Medical student, final year, Leicester Warwick Medical School saroosharma@hotmail.com

As a Hindu medic I could relate to the issues raised in this article. It was also very interesting to read about all the other faiths who had written similar articles in this series, and raise peoples awareness about other peoples beliefs.

While I appreciate that not all faiths can be covered, I was very surprised that you had not included an article from a Sikh medic. Having many friends who are Sikh medics, and hearing about some of the challenges they face (e.g in wearing a turban and patients' and colleagues responses to this), I think that this was a major faith which should have been included in your series.

LIFE
Medical students and their faith - being a Hindu medic
Sumita kini (October 2002) [full text...]

Wasiq (October 16, 2002)
House Officer, Royal Albert Edward Infirmary wasiq79@hotmail.com

I did read your artcle at length and could not help but notice how much, belief and pride in one's faith can sometimes hinder the appreciation of things higher. It seems to me that somewhere along the line we have forgotten that just being a good human being is what is enough for many things to be accomplished. Sounds very abstract? Allow me to explain.

By being a good human being one will rightly understand that there is ONE supernatural entity that created us for very specific reasons and living rightly is one of them. By "living rightly" one can be time conscious, hard working, success oriented, competetive in a very healthy way, smart, caring, charitable, having loads of sympathy and empathy and many more qualities than mentioned by you, and all this by not even being of a particular faith. But if you are still covertly insistent on your belief that one has to belong to one particular faith to be all this, then I invite you to try to learn a little about the monotheist relegion of Islam (out of intellectual curiosity if nothing else) with its emphasis on science and research and the distance it keeps from un-scientific rituals and taboos. Allow me to also let you know that the majority of the present followers of this faith are absolute public relations disasters. As George Bernard Shaw had rightly summed it as " a ! relegion without men and not men without a relegion". I am from India ( and I assume you have your roots too there) and I know how much Fanaticism, based to a substantial extent on a lack of understanding of one another's faith, is causing havoc. The article you wrote grimly reminded me of the kind of Hindu Nationalism that seems to be sweeping India and it is imperative that one stops and takes a stock of the situation. I wish you and many others all the best.

LIFE
Never say the "Q" word
Patric Davies & Adam Fox (October 2002) [full text...]

Dr S P Prabhu (October 01, 2002)
Specialist Registrar in radiology Bristol Royal Infirmary drsanjuuk@yahoo.co.uk

When I was working in India in the labour theatre, there used to be around 8 to 9 deliveries through a night shift lasting 12 hours. It was definitely busier on full moon days and there was more post partum bleeding seen in patients in one particular bed out of the five in the room.

This observation led to that bed being filled up only if the other four were occupied!! The midwives would try to persuade us to leave the bed empty for as long as we could!! So there you go... another superstition or is it????

LETTERS
Keeping the important issues in proportion
Davina Sharma (October 2002) [full text...]

Sameer Trikha (October 01, 2002)
Medical Student/ fourth year, Southampton University st298@soton.ac.uk

EDITOR - In response to Davina Sharma's article criticising the somewhat unbalanced teaching of certain issues such as infectious diseases at medical school, I can empathise with her view, but appreciate that the reasons for this '(mis)proportionation' are multifactorial. The point certainly is a thought provoking and interesting one; one could have the notion that as medical students, we must be trained in readiness for the everyday situations that we shall encounter on the wards and in general practice. We must also realise that preclinical and clinical teaching are often limited by time, resources and expertise, which are likely to vary between medical schools. For this reason, such constraints may result in the prioritisation of teaching according to importance: Heart disease will thus grab the lion's share of exam questions rather than Mucormycosis, and Diabetes the headlines ahead of Dengue fever. Major diseases such as these, collectively, impose a far greater burden on healthcare systems in comparison to certain infectious diseases. Therefore, is it such a bad thing to have these emphasised to students ?

However, there is a flip side to the coin in that the fashionable pickings may well end up taking the entire basket, leaving topics such as infectious diseases out in the cold entirely. This could result in doctors streamlined in their knowledge but unable to think past the third or fourth differential on their list, and furthermore, render them unable to deal with the more esoteric cases that they may encounter. Medical schools could perhaps define, more accurately, a 'core curriculum', to which each and every student is versed. This would serve to broaden horizons, and could enable appreciation and understanding of the global nature of infectious diseases. Additionally, SSM's could provide avenues for those wishing to further their interest in the subject.

	LETTERS Keeping the important issues in proportion Davina Sharma (October 2002) [full text...]
	Stephen Goldie (October 07, 2002) University of Glasgow, 4th Year stephen_goldie@hotmail.com
	Perhaps Davina Sharma has no intentions of working in the West of Scotland, but I would suggest that it is nonsensical for a future Glasgow graduate to want to spend more time learning about malaria than ischaemic heart disease. The "Big Three" of stroke, heart disease and cancer are the bread and butter of daily medical practice in Scotland. Wards are full of alcoholic livers; coronary care units are bursting at the seams; diabetics and CVA victims cost the NHS fortunes due to their long-term care and sequelae. I am yet to see one case of malaria.

	LIFE Medical students and their faith - being a Muslim medic Samena Chaudhry (October 2002) [full text...]
	Farrukh Malik (October 05, 2002) MBBS,Third professional year, Chandka Medical College,Larkana, Sindh,Pakistan farukhmalik@yahoo.com
	After reading the article of samena chaudhry, the thing came in my mind that she has rightly depicted the essance of Islamic teachings in relation with medicine.She has rightly said that via media only one aspect of Islam is widely seen by people around the world that is negative.Infact the things are not like that,only minority that is extremist has destuctive attitude.Above all the teachings of Islam,as presented by Muhammad The Holy Prophet(peace be upon him) of Islam, preach peace,love and brotherhood.Being a Muslim from the time I have started understanding the things I have been respecting the individuals around me without any defference of creed or religion and it is the real Islam.Even we can get lot of examples from the life of Muhammad The Prophet of Islam about it that He use to respect everybody equally.After knowing essance of Islamic teachings, being a Muslim Medical student/professional the first motive tobe achieved is "The Health OF Patient" bought! to you without any discrimnation and it is the prime worship/prayer.Atlast the thing that the writer has stressed in her article that doctors are agents of healing in the world but the actual cure is on part of God,I will say that in Holy Quran(the religious book of Muslims) it is clearly mentioned that seek the knowledge and do research, He(God) will reveal His secrets on you.In the light of that the knowledge of medicine that has emerged upto now is also a fruit of research and God has reveled some of His secrets and we can make some defference.We can benefit his creation "The Human Beings".

LIFE
Medical students and their faith - being a Muslim medic
Samena Chaudhry (October 2002) [full text...]

Zarin Siddiqui (October 17, 2002)
Final Year Medical Student, Dubai Medical College, UAE dr_euphoric@hotmail.com

I agree with Samena's article on the life of a muslim doctor. Living in a muslim country myself, I consider myself lucky in such regard that Islamic Medicine is one of the subjects that we study here. It really is incredible that the information that has been discovered in recent years, was present in the Holy Scriptures 1400 years ago.

I think that every muslim doctor owes a responsibility towards his muslim patients atleast. He/she must have enough knowledge about Islam and advise patients accordingly. To follow it must be left onto the patient himself.

REVIEWS
Medical students should not be forced to study all subjects
Kallur Suresh (September 2002) [full text...]

Hereward Hall (October 10, 2002)
Final Year Medical Student, Manchester hereward@abhall2000.fsnet.co.uk

I am in total accord with the author of this worthy thought-provoking article. Long gone are the days when the doctor was regarded as the fountain of all knowledge. Indeed, why waste so much valuable time trying to be exhaustive with a potential doctor's medical/surgical coverage.

Incidentally, in response to a medical student who disagreed with this viewpoint, I would remark that if a lady was in labour on an aeroplane, surely a midwife would be the best person! Admittedly, as a medical student one may have studied Obs & Gynae, but you can never come close to being as accompolished as someone involved in the frontline. If you are not very careful, you could do more harm than good. I believe there is little place for heroics in medicine any more. I think there is something to be said for quality not quantity, and I am afraid vestiges of the old medical frontier fall more into the latter department. Communication skills are certainly an excellent complement to medicine.

EDUCATION
ABC of sexual health: Assessing and managing male sexual problems
Alain Gregoire (September 1999) [full text...]

Isis (October 10, 2002)
super_poupoune@hotmail.com

I find only this section of the article interesting:

"Sexual fantasies, the desire for sexual activity, and distress about the level of desire in a patient and his partner all contribute to the construct of inhibited sexual desire. It is more commonly reported in women than in men (by both women and men) in the general population and in clinic populations. Differences in sexual desire often lead to considerable distress for a couple and can be a source of major conflict in the relationship.

Inhibited sexual desire is often associated with other sexual dysfunctions in the patient or partner. The lifetime prevalence of depression and anxiety disorders is increased. There is a strong association with emotional distance and conflict within a relationship, although it is impossible to determine whether this is cause or consequence from the studies available. Indeed, it is probably meaningless to attempt to do so from population studies given the great individual variability and the very gradual, transactional nature of change in these aspects of relationships.

Characteristic cognitive features have been identified in many cases - for example, the belief that desire does not gradually develop during a sexual encounter but must either be present at the start or does not occur at all, and the belief that subtle feelings such as warmth or tenderness are not sexual and that sexual arousal cannot take place without intense, overtly erotic feelings."

It was very uplifting to read this article, despite the fact that one can realize it by itself. I would have appreciated a more deeper analysis, daring to really get into the subject: why, how, what... type of questions. I guess this is not a subject that people talk about and yet I guess it hits on most normal considered people. Maybe if one could find links to other internet readings would be helpful. But it was very nice to read a clear, analytical and yet not medical verbage text on this subject.

	LETTERS Students should learn more than they need to know David Selvan (October 2002) [full text...]
	Guy Melrose (October 10, 2002) Liverpool University md0u8127@liv.ac.uk
	Sir, In this day and age I think that it is dangerous for doctors to believe that they know everything there is to know about medicine. We need to produce doctors who are competant at the job that they are going to be doing. That should include being able to apply basic principles so as to be able to cope with difficult situations, whenever and wherever they arise and whatever your specialist training might be. It would be wrong to think that you can teach, and that a student can learn, everything about every topic and be an expert in all areas. Medical schools need to ensure a good basic grounding to enable Junior doctors to perform their functions and they need to be provided with the skills to continue to learn throughout their working life. The role of the doctor has changed in modern society and the expectations of health care are much greater. In order to meet these demands doctors must never stop learning.

LIFE
Medical student and their faith - all articles
Zoe Apple, Suminta Kini, Samena Chaudhry and and Helen Barratt (October 2002) [full text...]

Fiha Jones (October 10, 2002)
2nd year Medical, Student University of Dundee fihajones@yahoo.co.uk

It was wonderful reading about the impact of various Faiths on the life of the authors. I felt it would only be fair to put forward the experience of a Humanistic medic.

There are those who do not have any religion. Those who are convinced that religions are neither accurate about life, nor always ethical in handling life's issues. (If anyone wants to discuss this, please e-mail me or get the sBMJ to open a forum on this if enough people are interested.)

They are humanistic, meaning that they are convinced that there is no divine power behind life and we're on our own in making a mess or making a difference. I am one of these humanists. Please hear me.

I see a suffering patient and I see a single cell with its unique genetic inheritance that morphed into the feelings of pain, fear and hope before me. The cell was shaped by exposure to a lifetime of nutrients, environment and experiences. The cell became an amazing individual who needs help because of the suffering that has befallen them. This has nothing to do with any divine plan, nor will there be any divine intervention. Just human care, knowledge and skills combining to effect a cure or at least a respite. In all our flaws, our frailties and our uncertainties about life, we can still remain humane and that's enough. To know that you did all you could because you cared about the lives of others.

LIFE
Medical student and their faith - all articles
Zoe Apple, Suminta Kini, Samena Chaudhry and and Helen Barratt (October 2002) [full text...]

Fiona Moreton (October 15, 2002)
2nd year Medical Student, Glasgow University fionamoreton@hotmail.com

Medical students and their faith (October 2002) invited us to appreciate then challenges and advantages of the Hindu, Muslim, Christian and Jewish perspective when pursuing a career in medicine. As a medical student with no belief in religion, my lack of belief in God also influences the way I approach being a doctor.

Being an atheist is difficult. For one, there is the not uncommon opinion that having no God means having no standard of morality. This may be down to apathy to rule following, egoism or an all-conquering desire for a hedonistic lifestyle. Now whilst my Christian background means I cannot claim my moral standards are purely influenced by humanist, atheist principles, I do not believe I have to worship God to have some concept of right and wrong.

A second problem is uncertainty. Not believing means death equals the end and innocent people do suffer and die horrible deaths. How do we live with such a realisation? The temptation to turn to God is strong, jut as those with religion face challenges to their faith.

So why not accept religion and let faith help me in my life and work? A belief in the beyond can give comfort and strength when illness and death enter our lives. It can give people hope and purpose and God can inspire charity and compassion. But on occasions some religious belief can create apathy to suffering just as atheism can. I do not reject God because of the crimes of religion, nor do I accept God because of the good works of religious people.

However, when you examine the underlying principles of most societies religion, variants of the phrase "Do unto others as you would have done unto yourself" and "Love thy Neighbour" do appear and are not purely of Christian origin. I can therefore live my life and practice medicine with these principles but without God.

So how does the atheist medic face the ethical challenges of euthanasia, abortion, or stem-cell medicine? Well I cannot answer for any other atheist or agnost or indeed anyone who does not have the rules written down. Ethical decisions are made with reference to a mix of philosophy, legal rulings, public opinion and subjective feelings. I have to recognise the innate subjectivity in the decisions I make but that does not mean I need religion to make the 'right' decision.

Ultimately I believe the faith or lack of it for everyone is a private matter and every medical decision is primarily between doctor and patient. It is for the patient to decide whether God is also involved in the consultation.

LIFE
Medical students and their faith - being a Christian medic
Helen Barratt (October 2002) [full text...]

Ross Carruthers (October 11, 2002)
Fifth year medical student, University of Glasgow R_Carruthers@hotmail.com

I read with interest the recent article concerning the Christian faith and its importance to medical practitioners. I also note that there is no article commenting on the beliefs of atheists and how atheism can contribute to the practice of medicine.

I would like to argue that in order to truly act in the best interests of a patient, a doctor must be completely non-judgemental. They should not hold strong views on issues such as abortion, sex before marriage, contraception, and other religious beliefs. The only matter which should be considered is the best possible option for that patient, even if they disagree with the theological convictions of the Doctor who treats them.

A christian view on patient's problems, (such as drug addiction etc) is primarily individually centred, and takes little account of the stresses and external pressures which affect that patient's health. Why is addiction a sin, whereas myocardial infarction is a pathology?

I feel that an atheistic view lends to a much more liberal attitude toward patients, with more acceptance of how patients choose to lead their lives. Atheism leads to a more detached stance and takes account of the factors which cause certain behaviours, instead of merely denouncing certain groups of society as sinners. Why is atheism so under-appreciated?

LIFE
Medical students and their faith - being a Christian medic
Helen Barratt (October 2002) [full text...]

Jude Reid (October 11, 2002)
Final year student, Glasgow University j.reid.7@student.gla.ac.uk

While I read with interest the article on religion and its relevence to modern medicine, I cannot help but wonder if these tales are significant on more than an anecdotal level. Appreciating the multicultural society in which we live is a vital component to sucessful medical practice in any field; religion, however, is and should be a deeply personal matter, and for that reason should not impair delivery of optimal health-care.

Helen Barratt speaks of her theistic ideology conflicting with contentious moral issues, and it is easy to imagine many circumstances in which opinions based on religious beliefs impair best treatment of the patient. Doctors must be impartial and base decisions on hard-learned science, not on relgious dogma - or even on personal beliefs. We do not spend our medical training learning how to become moral beings - it is hoped that we are those people already, and that our specialist knowledge is how best to apply knowledge to heal the sick.

I do not advocate universal atheism, but it is vital for an egalitarian society that the personal beliefs of the doctor do not impinge on the autonomy of the patient. Or, to put it in other words, let them go to hell their own way.

As a final point, many areligious medical students are quite capable of five years of study without excessive drinking, drug-taking or "sleeping around". Those that do, however, are as entitled to their lifestyle choices and social standards as Ms Barratt is to her life of moderation and restraint.

EDITORIALS
Child labour
Thomas J Scanlon and colleagues (October 2002) [full text...]

Chibuzo C Odigwe (October 14, 2002)
Medicine/3rd Year, University of Calabar, Nigeria chibuzo2k2@yahoo.com

I am writing in response to the article by Scanlon et al in the October issue of student BMJ. I agree with the authors on all the views expressed. In fact most of the issues they raised and referred to as what obtains in other countries like Indonesia regarding domestic servants also apply to Nigeria. In Nigeria, child labour is on such a pathetic scale that it has initiated and maintained a terrible vicious cycle where children who are supposed to be in school or engaged in some form of non/semi-formal education are subjected to labour, these children now grow up and become a burden to society, cause or increase the same societal problems that predisposed them to child labour, which in turn predispose other children to the same situation thereby perpetuating the cycle. In Nigeria,the predisposing factors are largely the same as that enumerated by Scanlon et al. Child labour is an issue which has generated a lot of "lip service", without anything substantial being done both at the local/community level and at the international level.

Without making an overstatement, most developing coutries are having their future existence jeopardized. A concerted effort is needed to address this problem.

LIFE
Medical students and their faith - being a Jewish medic
Zoe Apple (October 2002) [full text...]

Saul Kaufman (October 15, 2002)
final year medical student, sheffield neboch@yahoo.com

I identiifed very strongly with Zoe article, although not as exciting as Samoa I have felt like the only jew on occasion, for example when on placement in Scunthorpe or Grimsby. In Scunthorpe I did however meet a Jewish lady who told me I was the only other Jewish person she had met there for 40 years.

When I was on my elective in San Francisco a patient was getting very anxious and feeling potentially threatened I went out on a limb and asked if he was Jewish, although initially this made him more angry, after telling him where I was from etc. He became an incredibly patient - even cracking some rude jokes!

Being aware that I am part of a minority has, I hope, enabled me to be more aware of other people and ways of making them feel included.

EDUCATION
ABC of oral health: Mouth ulcers and other causes of orofacial soreness and pain
Crispian Scully and Rosemary Shotts (November 2000) [full text...]

John Fuhring (October 15, 2002)
outside observer, non medical jfuhring@rain.org

I am a male, 56, in otherwise good health. For 20 years I have had Angina Bullosa Haemorrhagica with blisters occurring 4 to 6 times a year.

In the early years and before I developed a treatment, a blister would quickly enlarge until it would burst on its own. The resulting large raw area would then become ulcerated despite attempts at oral antisepsis. These relatively large ulcers would become extremely painful and interfere with eating and even talking. After 10 to 14 days the ulcer would heal, but would require an active regime of strict oral antisepsis. By the way, eating dry corn chips seems to bring on a blister with a higher than normal probability.

Some years ago, as an experiment, I decided to lance the blisters immediately upon detection and before they could grow to a large size and burst on their own. I use a common straight pin that I always carry in my wallet for immediate use. The results have been very gratifying, as I have not experienced painful ulcers since starting this practice.

As you have probably guessed, I am not a medical practitioner, but not seeing this approach to mitigating the painful aspects of ABH elsewhere in the medical literature, I would like to respectfully submit my approach for your consideration