Article Responses: February 2003

Articles	Responses
NEWS Countries with better health systems have better football teams Roger Dobson (February 2003) [full text...]	John Araujo (January 24th, 2003) Read this response

REVIEWS Sleep Debashis Singh (February 2001) [full text...]	Alnela Mc.Leod (January 26th, 2003) Read this response

NEWS Consent for intimate examinations may not be adequate Mareeni Raymond (February 2003) [full text...]	Ed Bayley (January 26, 2003) Read this response Diana Chiu (February 9th, 2003) Read this response Layla McCay (February 13th, 2003) Read this response

NEWS Patients have more confidence in non obese doctors Clare Hughes (February 2003) [full text...]	Rajiv Malhotra (January 27th, 2003) Read this response

LETTERS Sessions in communication skills aren't an effective use of preclinical resources Oliver Lomas (February 2003) [full text...]	Stephen J. Goldie (January 29th, 2003) Read this response Jonathan R Dalzell (January 31th, 2003) Read this response Paul Blakemore (February 2nd, 2003) Read this response Jonathan Clark (February 5th, 2003) Read this response Marty Jackson (February 9th, 2003) Read this response Ismail Heyder Mohamed (February 12th, 2003) Read this response Helen Cunningham (February 13th, 2003) Read this response Laura Taylor, Alexandra Scott & Leigh Bissett (February 18th, 2003) Read this response

EDITORIALS Careers in Medicine do not attract bright school leavers anymore Elaine Griffiths (December 2002) [full text...]	Lewis Griffin (January 31th, 2003) Read this response

REVIEWS The Making of them: the british attitude to children and the boarding school system Petruska Clarkson (May 2001) [full text...]	Pauline Brennan (February 3rd, 2003) Read this response

NEWS Cigarette possession becomes illegal in Nova Scotia for under 19s David Spurgeon (February 2003) [full text...]	Clare Ruddock (February 4th, 2003) Read this response

REVIEWS Hyperhidrosis? No sweat! Anonymous (October 2001) [full text...]	Tommy Tung (February 13th, 2003) Read this response

	NEWS Countries with better health systems have better football teams John Araujo (February 2002) [full text...]
	John Araujo(January 24th, 2003) Professor, Physiology Dept. - UFRN - Brazil araujo@cb.ufrn.br
	This kind of relationship is very difficult when we talk about Brazil. Brazil is more then a country, because it is too big and has very regional differences. One part of Brazil has good health systems and other bad. In case we look for this kind of relationship in Brazil, we find the same, when we have better health systems have better football teams, when we worst health systems we do not have football teams. Brazil (one part) is not outlier, of course Brazil is the best footballing side.

REVIEWS
Sleep
Debashis Singh (February 2001) [full text...]

Alnela Mc.Leod (January 26, 2003)
Second Year student, Rutgers University, anela@hotvoice.com

I sympathize with you... greatly. I am only in college, but I have heard from many med students the same thing about lack of sleep, and its scary when you think about it. Not only do some med-students fall asleep on the road while driving home dead tired, but they are expected to be superhuman and do all things in their jurisdiction perfectly, without even the hint of a flaw, because they are to become Doctors. I think this system should definitely change. I am hoping that it does change by the time I get to medical school. Tell me, have you and your fellow med students done anything to combat this cruel practice?

When you do sleep, I wish you peaceful rest and sweet dreams of a more perfect world :)

NEWS
Consent for intimate examinations may not be adequate
Mareeni Raymond (February 2003) [full text...]

Ed Bayley (January 26, 2003)
5th Year Medical Student, Nottingham mzysejb1@nottingham.ac.uk

I read with interest the above article on consenting patients for examination, especially the fact that many students did not know whether consent had been obtained or not.

It is now over a year since I did my Obs and Gynae attachment, but I can remember well the embarassment I felt on having to obtain consent, never mind the patients embarassment / anxiety. As a student I was expected to try and obtain consent from every patient that went into theatre. Although many people would say I was over zealous, I would never examine a lady unless I had got their written consent in their notes first.

What surprised me was the senior doctors' reactions to my actions - even in the current climate of litigation, they felt it unnecessary to go so far as to get written consent. I on the other hand, preferred not to take the risk of a patient changing their mind afterwards and myself then having no evidence to 'cover my back'.

I agree with the article, that students need to take responsibility for gaining consent, especially as many experienced senior doctors are still behind the times with regards to modern practice. I feel that at the very least it is naive for a student to expect consent to have already been sought, and at the most plain stupid. Also, students should never feel pressured into having to examine the patient, just because a consultant is foreboding, especially if they have no idea as to the patient's wishes.

Patients are the only resource for us to gain proper experience of clinical practice on, however they should not be abused. One should always get consent for anything they do, and for the more intimate consultations, written consent should be a necessity. However, I also think that senior doctors should also be brought up to speed on 'modern practice', as it is no longer acceptable to a) assume that the patient will not mind, or b) to pressure a student into doing something they feel is unethical. I also feel it is unacceptable for us, as students, not to take more responsibility for our actions. Eventually we will not be able to use the excuse: "I'm a student , I didn't know I was meant to".

CAREERS
Consent for intimate examinations may not be adequate
Mareeni Raymond (April 2002) [full text...]

Diana Chiu (February 9th, 2003)
4th year medical student, Manchester University Diana_y_y_chiu@hotmail.com

After the reading the recent bmj article on the issue of inadequate consent for intimate examination, i became very dishearten. However, this is not because i shared the same experience as the many medical students quoted, but quite the opposite.

Thoughout the whole of my clinical experience so far, the issue of informed consent has been emphasied repeatedly, we would fail many of our examinations if consent wasn't asked for. None of the consultants would ever pressurise us into doing any examination without prior consent- sometimes written. However, the issue of consent has made many doctors weary of giving medical students the chance to do any initimate examination. If the medical student doesn't do anything, then there is no need to ask for consent and he/she will avoid the media coverage if anything goes wrong. Additionally, doctors feel that it is an added burden to their clinic times to ask for consent for the medical students to do examinations as well.

Although i agree that consent is very important and that the medical student should take some responsibilty, it is not always possible to get prior consent. For example, if a clinical opportunity arises in theatre and the patient is anaethesied, the student will miss this chance to practice because he/she has not forseen this and has not asked for prior consent.

I feel that as a medical student i have been denied the much needed clinical experience because of the extra emphasis of consent, if there are extra protocols such as signing consent forms then this will further hinder my experience. In the past, when ethics was not such a huge issue, medical students gained much more clinical experience. For example, 20 years ago, medical students in manchester had to do 50 deliveries of babies before qualification, but now i can't even do 1 due to the process of asking for consent. Understandably, once the parents know that a medical student is asking to delivery they become afraid and will not consent. The next time i am asked to deliver will be when i qualify and it is likely to be an abnormal birth. By that time, i am expected to know what to do because i am the doctor - despite the fact that i have not even done a normal delivery.

There is oftentimes no other way to learn some clinical skills without practice on real patients. Doctors are feeling apprehensive to give clinical experience to medical students in this day and age of increasing litigation. Therefore i feel that i am not gaining the adequate clinical skill and experience. This recent article, especially by a medical student, will further exacerbate my chance to practice examinations.

NEWS
Consent for intimate examinations may not be adequate
Mareeni Raymond (February 2003) [full text...]

Layla McCay (February 13th, 2003)
University of Glasgow, 4th year medical student laylamccay@hotmail.com

I recently completed my attachment in Obstetrics and Gynaecology and always got the patient's consent before I examined them in theatre. I believe it is the student's responsibility to ensure that written consent has been given and if I knew that somebody had not consented, I refused to examine her, regardless of the opinions of any doctor present.

In the hospital to which I was attached, there were two aspects to the medical student consent form: consent for the student to be involved in the procedure, and consent for the student to perform an internal examination. Of all the women I asked, not one refused consent for my involvement in the procedure, but several would not permit me to examine them. Attitudes like this reflect the fact that many patients do not understand what will happen to them in theatre: repeated internal examination is often part of a gynaecological procedure rather than an optional extra for students. Student involvement often requires procedures as intimate in nature as internal examination, for instance manipulation of the cervix. Does this mean that the "student being involved in the procedure" section ought to cover vaginal examination too? Or that students ought to abstain from involvement that demands internal manipulation when the patient has not consented to internal examination?

NEWS
Patients have more confidence in non obese doctors
Clare Hughes (February 2003) [full text...]

Rajiv Malhotra (January 27, 2003)
medical student, third year, University of Liverpool rajivmalhotra@doctors.net

I am writing in response to Clare Hughes' article, which focused on a study that suggested obese physicians inspired less confidence in their patients than non-obese physicians.

At medical school, the thought of living a healthy lifestyle is somewhat overwhelmed by the endless kebabs, pubcrawls and left-hand-drinking-only nights.

Exam stresses mean that jars of coffee replace bottles of water and microwave 'ready-in-minutes' meals take over the freezer space.

Before entering into medical school, a doctor told me that to get through all of the work at medical school I should "shower quick, eat quick and sleep less"; hardly the most health-conscious of adages.

Common sense would tell us that preaching of the virtues of a healthy diet to patients, whilst being a few pounds overweight oneself, is not ideal and could indeed affect patient satisfaction.

But how far can we extend this idea? Should we allow smoking cessation advice to be given to patients by health professionals who smoke? Some may argue that these health professionals may be the perfect people to give advice, as they would understand the problems and barriers to this and be able to give more effective and practical suggestions.

The idea that the management of future patients can be affected by personal lifestyle choices made by doctors, usually whilst at a young age, is worrying. However I believe that patient satisfaction on such issues is much more dependent on a doctor's personality, knowledge and communication skills; it is in these areas that I believe we should focus on whilst at medical school.

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Stephen J. Goldie (January 29, 2003)
Fourth Year Medical Student, University of Glasgow Stephen_Goldie@Hotmail.com

For a first year student at Oxford University, I think that Oliver Lomas has prematurely spurted forward his views on the subject of communication skills.[1]

As one of his more senior peers I can re-assure him that time spent learning communication skills is not time wasted. It is important to understand that there is a world of a difference between common conversation and a professional medical consultation. I tend to agree with Abi Coleman that medical students require a "blend" of the traditional academic subjects and the new 'touchy-feely' topics.[2] Coleman, speaking from experience, puts forward the far more sensible proposition that we should have communication skills and patient contact from the very beginning of our medical courses.

The University of Glasgow has a very similar sounding course to that, described by Coleman at the University of Birmingham, with early hospital and GP visits, complimented with timetabled communication skills sessions. Our very integrated course was treated with some scepticism and derision when the faculty took the very bold decision of reverting from the antiquated tradition curriculum. The first group of students taught by the integrated method graduated in 2001. As far as I am aware there have been no dramatic increases in mortality rates in the Greater Glasgow area. Some students are naturally gifted in their ability to relate with patients. Perhaps Lomas is one of these: time will tell.

Lomas O. Sessions in communication skills aren't an effective use of preclinical resources. Student BMJ. 2003; 11: 36. (December)
Coleman A. Patient contact in preclinical years makes good doctors. Student BMJ. 2002; 10: 476. (February)

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Jonathan R Dalzell (January 31, 2003)
Final Year Medical Student, University of Aberdeen u05jrd@abdn.ac.uk

Editor-I am writing in response to Oliver Lomas' letter claiming that teaching sessions in communication skills are not an effective use of preclinical resources as they take up time that should be devoted to the teaching of the basic medical sciences.

I feel that effective inter-personal communication has rightly become one of the most crucial aims of modern medical education and that communication skills should not play "second fiddle" to early basic science teaching.

There is more to modern healthcare than simply identifying and treating a disease process, and a profound knowledge of the underlying biochemical or pathophysiological aspects of a certain disease process is useless to a clinician if he or she lacks the ability to interact efficiently with a patient in order to take a comprehensive clinical history.

The importance of introducing communication skills teaching at the earliest possible stage in an undergraduate course should not be underestimated. The ability to communicate in an effective and professional manner with patients and fellow health care professionals, perhaps under stressful circumstances, enhances the confidence of students leading to them becoming more comfortable in the clinical setting, which can be initially daunting. In this way students with better developed inter-personal skills are more likely to gain more from clinical teaching than keen, but lesser prepared individuals, who may become disillusioned by their initial inability to interact with patients as effectively as they would wish to.

Of course we should all strive to accrue as much knowledge as we can, but this should not be to the detriment of communication skills teaching. The "old school" attitude that communication skills should take second place to acquiring knowledge should be abandoned in 21st century medical teaching if students are to take the maximum amount from their undergraduate years and provide optimal healthcare to their future patients.

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Paul Blakemore (February 2nd, 2003)
2nd year medical student, University of Durham, Queen's Campus paulblakemore@tinyworld.co.uk

Oliver Lomas is missing the point (Student BMJ, February 2003). The need for medical schools to produce more well-rounded and socially aware doctors although having some political basis is nonetheless a very real one. Firstly because this is what the public wants (and deserves), and secondly because of the medical professions own long-standing recognition that medicine encompasses not only science but elements of art too, an area that has traditionally been neglected to the detriment of the profession.

Of course obtaining a thorough understanding of the medical sciences is of fundamental importance to future clinical practice, but unless you can discover what motivates a patient to present, recognise why they act in the way they do and relate at some level to where they are coming from, then I fail to see how you can practice effective medicine.

Although I would agree some role-plays, etc. are a little contrived, social awareness and communication skills do not lend themselves solely to self-directed learning - but neither can they be taught rote style. Medical schools are only attempting to accomplish the introduction of concepts with which the student can build upon. Relying on students to work in their own time is not a viable option; there are only so many who could, and realistically only so many who would.

Progress is not being made at the expense of medical knowledge, in fact the opposite is true, it's being made in order to expand it. Although current educational methods don't always get it quite right, view them in the manner in which they are intended - that is rather than cheapening medical education they are a genuine attempt to enrich it.

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Jonathan Clark (February 5th, 2003)
1st year BM,BS, Peninsula Medical School (Universities of Exeter and Plymouth,) jonathan.clark@students.pms.ac.uk

I write in response to Oliver Lomas` letter arguing that communication skills should be self directed to allow more curriculum time to be spent on medical sciences during pre-clinical training(1).

Whilst I agree that no one part of so-called pre-clinical training should be reduced or excluded at the expense of another I would disagree with his notion that communication skills should be learned through self directed out of term patient contact.

Having been in clinical practice as a medic in the Royal Marine Commandos for 3 years prior to attending medical school, I would argue that self directed learning is more easily applied to biomedical science than it is to the learning of clinical or communication skills. Textbooks, models and interactive learning aids exist for the student to learn the principals of anatomy, physiology, pharmacology etc. The process of reflecting on and learning from patient contact in any meaningful way is, far more difficult by oneself. During hospital placements in years 4 to 6 I am told little if any time exists for this at all and during this time habits in patient approach will be formed. A good understanding of communication skills before entering this frenetic and stressful period can only be a good thing.

A recent article in this journal stated that research has shown those surgeons who are apparently less caring in their verbal communication are more likely to find themselves on the receiving end of a malpractice suit(2).The researchers stated that post graduate surgical training in the U.S. would be revised as a result of this study. This is not to say that threat of litigation should determine the setting of undergraduate curriculum. But it does demonstrate how patients view doctors that communicate poorly with them, with the obvious implications that this will have on the doctor-patient relationship.

Lomas.O Sessions in communication skills aren`t an effective use of preclinical resources Student BMJ 2003 11, 37 (February)
Dobson. R Hidden meaning in a surgeons voice Student BMJ 2002 10,34 (September)

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Marty Jackson (February 10th, 2003)
1st year MBBS, University of East Anglia marty.jackson@uea.ac.uk

In his letter (Feb 2003 issue) Oliver Lomas fails to realise that an integrated curriculum doesn't mean that communication skills are taught at the expense of medical sciences. In fact my integrated MB/BS degree curriculum will have the same proportion of medical science as that of a traditional preclinical/clinical degree. The difference is that we are taught a balanced curriculum throughout the 5 years rather than cramming the clinical in at the end. Every piece of medical science we are taught is contextualised by clinical experience. Our patient contact is not token but very relevant to our school-based studies.

Having just completed 4 weeks of secondary care placement, it was evident from the comments of the consultants who tutored us that they were impressed not only by our ability to communicate with patients, but also at our competence of history taking and our ability to apply our school-based knowledge in a clinical setting. For me personally, the patient contact reinforced and enhanced my learning far greater than any textbook could ever do (although, for the record, we still use these).

It shouldn't be assumed that progress is at the expense of medical knowledge just because we aren't now required to learn by rote and regurgitate facts like parrots as those who have gone before us used to. The story I hear ad nauseam from my mentors is that most of this knowledge promptly vanishes seconds after the exam or viva has finished. If an integrated curriculum puts an end to this ridiculous practice then that is reason alone. Dumbing down it certainly isn't though.

As for cheapening medical education, well I know this isn't true. One of my colleagues recently presented her student selected study on medical education and showed the cost of an integrated medicine degree course to be broadly similar to that of a traditional one. Very interesting I thought at the time though I failed to take any notes.

It amazing, you never know when your integrated broad-based learning will be useful until the situation arises and you realise it was always there even though you hadn't memorised it like a parrot.

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Ismail Heyder Mohamed (February 12th, 2003)
Medicine 4th year, Leicester Warwick Medical School ismailheyder@yahoo.com

In response to Oliver Lomas' letter, I would not go as far as to suggest that the current medical curriculums in which sociology and its allied fields are taught as core modules (certainly in our medical school) are part of the dumbing down process designed to accelerate the government's ambition to make more doctors to fill more seats in parliament.

It may be true however to suggest that there are many equally important fields of science that a medical student needs to be firmly grounded in, such as neuroanatomy, that are not allocated its rightful place either in terms of teaching or practice in pre-clinical years.

It is widely known that one of the main reasons why patients initiate legal actions is because of lack of communication between them and the doctors. I have seen cases in which the glaringly obvious have been missed, which if the patient was to pursue would almost definitely land the doctor in hot waters. It is perhaps important then to develop communication skills early on, and ingrain a sense of honesty and openness in communicating with patients.

Lastly, as I have learnt through experience (and I am sure many others!) that one of the most tried and tested means of learning one's anatomy and physiology is by being drawn into a 'constructive' questioning session often in front of patients by consultants.

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Helen Cunningham (February 13th, 2003)
2nd year medic, St Georges Hospital Medical School ms015600@sghms.ac.uk

I am writing in response to Oliver Lomas' letter about the use of communication skills courses and patient contact in the medical curriculum.

I believe most students enter medicine with the intention of becoming a good doctor. To achieve this students follow a medical curriculum that gives a broad base of knowledge and skills to enable personal and professional development, along with a knowledge of clinical science.

As a doctor it is essential to be able to communicate effectively. This entails elements of both verbal and non-verbal communication that do not come naturally to everyone, but which everyone can learn or improve upon with appropriate guidance.

Evidence for the importance of communication skills can easily be demonstrated. It is very difficult to try to explain an embarrassing problem to a GP who will not look you in the eye, has their arms folded across their chest or simply cannot express an empathic reply. It has been reported that the majority of medical negligence claims and complaints are due to a lack of, or problems with, patient-doctor communication. Surely it is our responsibility as "tomorrow's doctors" to rectify this situation as far as possible, for both our sake and that of the patients.

For medical students, who are by definition intelligent, it is simple to look up the glycolysis pathway or read about the process of carcinogenesis in the library. It is far more difficult, however, to teach yourself communication skills effectively. Furthermore, students should not need to be spoon-fed; they should be prepared to expand on information given in lectures, using it as a framework for self-directed learning.

At St George's a communication skills course has been evolving throughout the new curriculum and now includes workshops, videotaped simulated patient interviews and most importantly, in my opinion, contact with patients. I have found this extremely useful in honing my skills as a communicator and seeing the positive effect this has on professional relationships. Moreover, gaining an insight as to how it feels to be a patient and learning the importance of listening has increased my enthusiasm for my chosen profession. I believe that the time and energy tutors and patients invest in this course is invaluable and should be greatly appreciated by all those fortunate enough to be participating. After all, the patient is why we practise medicine so why should contact not start with medical training.

LETTERS
Sessions in communication skills aren't an effective use of preclinical resources
Oliver Lomas (February 2003) [full text...]

Laura Taylor, Alexandra Scott & Leigh Bissett (February 13th, 2003)
University of East Anglia L.Bissett@uea.ac.uk

We are writing in response to the letter regarding patient contact in preclinical years not being an effective use of resources dated February 2003. As first year medical students from a new integrated medical course we felt that the comments made were based upon weak premises, more specifically a lack of evidence (hardly good practice in our evidence based profession).

'There are an increasing number of integrated medical courses which teach pre-clinical skills in a different fashion to the more traditional schools. However, I must iterate that it does not detract from our scientific education taught through the medium of lecture, seminar and plenary groups focusing on anatomy, biochemistry etc. In addition, we are taught the importance of psychology and sociology in medicine, of equal importance when considering recent publications by the GMC (i.e. Tomorrows Doctors). This new teaching approach allows us to consult with patients in a more holistic manner and to understand that there is more to a patient than their acid - base balance or atherosclerosed aorta. Teaching a person science is a relatively simple procedure. Educating a person is far harder and a much more beneficial concept in the continually changing medical profession. The PBL system whose origins are Canadian aim to provide continuous scientific learning that can be directly applied in a clinical situation. Teaching on a Monday is practiced on a Thursday rather than waiting two years, by which time knowledge may have been lost.

Early clinical experience means we see the problems medics and other health care professionals face. We are given a greater appreciation of multi - disciplinary teams and the likely scenarios we will face upon qualification. We talk to patients and their families as well as examining their illness. From past experience I know that people want doctors who listen and communicate - who are people themselves. A patient demands a Doctor who has a good scientific knowledge but if they lack basic communication and inter-personal skills this knowledge is wasted!

In conclusion, the new schools have the backing of the GMC and government with the needs of patients being the very ethos upon which they were created. We as a school recognise that many people feel intimidated or even afraid of change but speak to any of the patients, doctors and medical-educators and I am sure they will give you a more informed opinion than those previously expressed in the student BMJ letter.

EDITORIALS
Careers in Medicine do not attract bright school leavers anymore
Elaine Griffiths (December 2002) [full text...]

Lewis Griffin (January 31, 2003)
3rd year medical student, University of Leeds leedswams@hotmail.com

A potential applicant to medicine faces many obstacles before the long-hoped for offer arrives through the letter box. If they are lucky, they will receive accurate, up to date information, support, and encouragement from their careers teacher at school. Working at conferences aimed at sixth formers interested in medicine reveals that this is not always the case. Misinformation and myths abound - 'ignore what the prospectuses say - you must take 3 sciences', 'you'll never succeed at interview with that regional accent,' and even 'wearing a pinstriped suit will communicate arrogance - you need to wear something more compassionate.' Negativity at this early stage puts off many; myths fill those remaining with fear and confusion. Those who soldier on must organise work experience which can be difficult without the right contacts, a proactive school or a Trust organised scheme. Some students receive excellent advice on writing their personal statement and have comm!

endable opportunities to hone their interview technique. Unfortunately not all schools have as much experience in dealing with applications for medicine and HE in general. Business run conferences exist to provide these opportunities but their hefty price tag puts them out of reach of the very students who might benefit most.

The picture painted is of an uneven playing field; with some students suffering a huge disadvantage. The resulting intake of medical students is a poor reflection of the diversity of our society.

A fledgling Widening Access to Medical School (WAMS) scheme at the University of Leeds is a promising way to level that playing field a little. Student led but with the full support of the medical school and the LEA we provide medical student mentors to sixth formers interested in medicine. We especially target schools in difficult areas, as identified by Widening Participation workers at the University. The mentors provide the accurate information, support and encouragement that is so often missing, give advice on interview technique and personal statements and try to answer any other questions that may be asked.

It is easy for medical students to forget the deiform appearance of the profession to those who aspire to be part of it; perhaps the most important aspect of WAMS is the one to one contact it offers with someone within the system - and the reassurance that contact provides.

REVIEWS
The Making of them: the british attitude to children and the boarding school system
Petruska Clarkson (May 2001) [full text...]

Pauline Brennan(February 3rd, 2003)
Registered Nurse,BHsc, PG dip PRHC, Otago Uni omamari@landcorp.co.nz

The review of Duffels book really hit home for me. Our son is into his ninth day at boarding school (the "best" boys states school in New Zealand). He is having a terrible time of homesickness, crying, vomiting, not eating, not sleeping (due to dorm raids). His class has been changed as the last teacher threw books around - all a bit daunting for a 13 yr old. The "masters" are all very nice and the matrons are very motherly, but the old addage of " its the transition from boy to man" , and "its cutting the umbilical cord" keep being spouted and are certainly wearing thin as an excuse for his spiralling health, self esteem, and psychological well being. Everyone says to "stick at it" and for him to keep trying. But when is enough enough? If anyone has any thoughts out there or personal experiences I,(a caring mum)would really appreciate hearing from you.

I'm off to the library for Duffels book "the Making of Them".

	NEWS Cigarette possession becomes illegal in Nova Scotia for under 19s David Spurgeon (February 2003) [full text...]
	Clare Ruddock(February 4th, 2003) 4th year medical student, leeds university ugm8csr@leeds.ac.uk
	Nova Scotia should be commended for trying to do something to stop the disease and suffering caused by smoking not reprimanded. Back in the distant past at school I remember smoking as the height of coolness. Now after the experience of only four years of medicine smoking appears to be the most abhorrent habit. Time and time again I am told that smoking is a risk factor for an illness, that if a patient stopped smoking their morbidity would decrease dramatically and of the tremendous burden that smoking places on the state. Therefore I cannot help but think that anything done in an attempt to stop young individuals from trying that first cigarette should be encouraged not dismissed. Maybe Nova Scotia is being too severe but at least it is a step in the right direction.

	REWIEWS Hyperhidrosis? No sweat! Anonymous (October 2001) [full text...]
	Tommy Tung (February 13th, 2003) 1st year, USC graduate cinema-television tungtalk@hotmail.com
	Just wanted to say I'm glad that surgery worked well for the author the article. I have moderate palmar hyperhidrosis, and have researched a lot about its treatment on the Web. I tried Drysol, didn't like it, thought about surgery, but my father, a plastic/reconstructive surgeon, advised me against it. I've read some responses from dissatisfied patients who have undergone surgery. I'd like to think that there is a way to treat the cause of hyperhidrosis--and while some doctors may say it's caused by the malfunction of the nervous system, I've found that at times, when my state of mind is tranquil, when my body is as equally as calm, my hands are not excessively sweating. I'm exploring the option of relaxation techniques, such as meditation and guided counseling. Feel free to tell me what you think of my approach. I've had the condition since my adolescent years and didn't know its name until I was 23. I gather that there are many young people out there who aren't awa! re either. For a long time, I thought I had some thing nobody had. I'd like to think that with the awareness of hyperhidrosis, people don't need to feel alone anymore.