Why Sleep Matters

I, as numerous others my age have experienced consecutive nights of staying up late till ridiculous hours of the next morning and then being encouraged to wake up approximately 5 hours later to prepare for a busy day of school. It’s no wonder that after one year of repeating this routine with myself that I have felt the consequences of a lack of sleep. Although I feel that I have such a wide variety of distractions, namely the internet, homework, reading books, social media and of course watching films that I prefer to do at night.  

Within the first week of my summer holidays I have relished the knowledge that I can sleep until the late afternoon of the next day in order to compensate for how tired my body was, given that I didn’t really think I was too tired throughout this year of school.

So I have decided to try and convince myself and others of the importance of sleep, how getting sufficient sleep can affect our daily lives and hopefully improve the way we face each day.

Sleep deprived people may experience apathy, slowed speech, flattened emotional responses, impaired memory and an inability to be novel or multitask. It has been shown that sleepiness does take a toll on effective decision making. In addition to this alert people are sensitive to how much work they should do and the risks involved in them.

We know that getting enough sleep is a key part of a healthy lifestyle, it can benefit your heart, weight and mind. Moreover, I recently watched a documentary that highlighted the results of sleep in literally clearing the circuitry of our brain from a protein that renders people more susceptible to developing Alzheimer’s disease in the future. When we sleep, our body heals damaged cells, boosts our immune system, allows us to recover from the day’s activities and recharges our cardiovascular system.

The sleep cycle includes two repeating phases:

REM = rapid eye movement. Dreaming occurs, where our minds process and consolidate emotions, memories and stress. Vital for learning, stimulating the brain regions involved in learning and skill development.

NREM = non-rapid eye movement. Tissue growth, repair, energy is restored and hormones that are essential for growth and development are released.

When we don’t get enough sleep we feel drowsy, depressed and are easily irritable. Learning is difficult, storing things in our long term memory is also a challenge. As well as this we crave more unhealthy foods that can cause weight gain and inevitably more health problems.

For one week (I know that’s a lot for me!) during the school year, I decided to increase the amount I slept each night by at least an hour. I’m not exaggerating by saying that I definitely noticed the effect of a full night of sleep. I worked so much faster at school and was keener to be involved in things. Then after my school day I have a part time job (tutoring children) in which I greatly noticed that my efficiency in working was so much better! Unfortunately I found it difficult to keep up this trend given that I had a lot of responsibilities and things to accomplish before each school day that meant I needed to stay up. However I hope to repeat this during the more stressful moments of year 13 to benefit from better health, mood and logical thinking!

 

 

Sources of information:  

http://www.webmd.com/sleep-disorders/features/9-reasons-to-sleep-more#3

http://www.resmed.com/us/en/consumer/diagnosis-and-treatment/healthy-sleep/what-happens-during-sleep.html#

 

Thoughts on Work Experience

 

Today I’d like to share some brief thoughts on previous work experience. I am lucky to have been able to achieve a wide variety of work experience over the course of my late secondary school years and also currently in year 12. For instance these include GP surgeries (with HCAs, doctors and nurses), the local hospital (consultants and physiologists), primary schools, occupational health centre, volunteering and part time occupation. From all of this experience I have gained a great amount of knowledge to start building the foundation of skills that will help me in my aspirations for a future career in medicine and I hope to express just a snapshot of what I learned to you.

One day shadowing a GP:

This was no ordinary day in a surgery, of course that is a one of a kind experience that I will get to later, however now I am going to talk to you about something different. On this day we travelled to the offices in Abingdon at Doctors.net.uk. It is a small company which aims to provide education services, networking for medics and advising others, whilst promoting certain drugs. Here, the particular doctor has incorporated this alternate role into his duty as a GP. I found this really eye opening as most of us assume that in the future you choose one particular specialty which itself may be filled with wonder and excitement, but you might not have vastly different daily experiences with regards to the environment you are in.
The doctors can advise and promote drugs and the proper use of them. GPs are required to update their knowledge on certain issues. I have found that they receive data for the most common drugs, which is useful to identify those that are the most important for the company. Moreover, various types of media are used. For instance social media, what should the GPs do and not do and how to target this by arranging GP training programme appraisals. It is very interesting to note that the media’s role in medicine also is quite prominent and it allows us to be influenced based on our demographic.

Later I was taken around to meet the other departments such as the Market research team who try to ask the doctors meaningful questions to receive responses that make scientific sense as well as offering a slight incentive. Why would a doctor be interested in a drug unless they see it as a relevant addition? There is a balance between working with industry and working with the community of doctors.

Following this we worked on an article the GP was involved in for Women’s Own magazine, it highlights the methods in which people self- diagnose their illnesses using technology and how these searches can be successfully refined. Must adjust the language style of this article in order to make it more understandable to the general public.

Another day with a consultant at the general hospital:

I shadowed Dr R in the outpatients section, he is a Consultant Physician in General and Respiratory Medicine who deals with multiple cases and events in this speciality. From this day I learned to appreciate the level of activity and hard work all members of the hospital do to keep the internal mechanics running smoothly.

For example with one patient the consultant begins the appointment with some friendly conversation about similar languages to be friendly when introducing himself to new patients, I found this comforts them and the sense of having something in common with your doctor enables you to feel more at ease in the appointment. So this patient had a chest infection, started taking Clarithromycin which unfortunately gave them stomach aches for a Haemophilus influenza. Now they are on Amoxicillin. A longer interval between the return of the infection is not good, the key is to hit it hard when it returns. The infection in airways obstructs easy breathing. Advises them to have some burnt toast at night because the carbon in the burnt parts absorb things in the stomach to improve sickness. Has lots of bacteria that have eventually colonised her lungs so this illness will not ever go away unfortunately.

The following patient has recently had a chest scan due to having had a bad back pain. Goes through the CT scan with them and finds the large lump in the lungs. Pressing on the spinal cord. Need to work out what this growth is. Must extract the tissue to test it, can use a needle to extract it/ could be coming from the gland. Must find what is as the origin and how far it has developed. Pain is radiated due to nerve line. Can put a bronchoscope with a camera down the throat to examine what is inside, in order to find some answers as to what is going on in his chest. Informs him that they don’t really know until they carry out more tests and that they are actually worried about it being a cancerous growth. Asks about any medications that they take (Paracetamol/ibuprofen/tramadol) to control his pain. Then prescribed medication to see if he can manage his sickness symptoms better. Now listens to chest. This person still smokes, will give him some help for this. Has been smoking since 15 years old. Previously a painter/ decorator so it is possible he has been exposed to many fumes, it is important to consider many of the other factors their lives that contribute. Full extent of breathing and expanding the lungs is inhibited due to the pain. Recaps plan of what they should do / which treatment they need. Asks how far he can walk on a regular day. Acknowledges that it may be a worrying time for the family, there is no point looking backwards. The pain he feels is generally as a result of something else and they need to find out what this is first. Will then do a breathing test, may need Radiotherapy. Bronchoscopy will happen, it enters up the nose, past the voice box and then down the trachea. Takes a small piece of tissue to assess the extent of the disease.

With this patient I learned that the doctor displayed a number of essential qualities of a good doctor. Such has having the empathy, sensitivity and the ability to communicate your plan of action clearly and in a way that reassures the patient that they are in good hands. Moreover I found it fascinating how the consultant was able to quickly sort through all the relevant knowledge to then make the right decision as to what the best route for the patient’s treatment should be.

The doctor then records a review of the clinic of previous patient in the morning so the secretary will dictate it. In Dr R’s opinion, some good qualities of a doctor include knowing how to prioritise, being hard-working, having the ability to make quick decisions, have good communication, to really care about others and be organised. Difficulty of being a doctor is trying to get through a lot of tasks in one day and feeling as though you didn’t do it properly. A lot of pressure and expectations on people in the NHS to complete everything or check the patients and make the correct decisions when pressured with time.

Then I spent the afternoon at the wards with some of the junior doctors. Dr W and Dr E. They check up on the elderly patients in the beds that have to stay in the hospital for a long time. First patient has an aspiration pneumonia, checks for breathing, tripod positioning, also muscle movements in the neck. Has a scoliosis and a curvature in the back which could obscure her breathing. Checks their oxygen saturation / urination. Status of wellbeing meant that she will stay here till she settles or until she has completed the course of antibiotics.

Moreover, people in hospitals are assessed on their risks of having a blood clot in their legs/lungs from not moving around enough during the day. So they weigh up the risks of having a venous thromboembolism and also the bleeding risk. They then enquire with care homes about having any relevant information passed on to them about a specific patient.

Doctors must document most things that they discuss with patients on the ward round. Look at the results, observe how other people present the patient / if they have improved since having stayed at the hospital.

Evidently there is very effective teamwork between the different departments of the hospital and the links with junior doctors which I found to be useful when they are dealing with different cases. The consultant met with such a wide variety of patients, all with their own individual stories and outlooks that allowed me to gain a much bigger picture of the responsibility of a senior consultant. There is a lot of expectation from the patient on you as a doctor, but having the ability to listen to the patient well and use the time effectively to gain sufficient information from this history seems to help you in making a clear and coherent diagnosis.

I am extremely grateful to all members of staff that made these experiences possible. During each unique opportunity I was able to meet a range of exciting people, including the patients and staff who all shared a little bit of knowledge with me that shall hopefully go a long way in the future.
Although I haven’t gone into too much depth about all the things I was involved in, I hope that this can give you a background as to what my experiences were like.

 

 

Infectious diseases – an interesting story

rimk 
http://string-db.org/version_10/newstring_cgi/show_network_section.pl?all_channels_on=1&identifier=199310.c0985

A recent article that I read showed that scientists in the John Innes Centre have disabled infectious bacteria by removing a key protein. In the University of East Anglia they discovered a method that could prevent bacterial infections in both humans, in addition to this it doesn’t trigger a multi – drug resistant response.

A bacteria has to first move across the surface to a site of infection within the host. One of the scientists at the School of Biological Sciences (Dr Jacob Malone) wondered why there were high levels of a particular protein in bacteria when in contact with plants. They found that this protein is a high – level controller of bacterial movement during plant and human infection. Therefore this can become a target against which to develop anti – infective drugs seeing that the bacteria are not totally killed it just reduces the chance of bacteria evolving to develop a resistance to them.

They studied a bacteria called Pseudomonas – of which a strain causes around 7% of hospital acquired infections in the UK and is a major cause of the mortality in cystic fibrosis patients. The main ability of Pseudomonas to cause infection is totally compromised at an early stage when one key protein is removed from the bacterium. This protein is known as RimK and is found in hundreds of species of bacteria although its specific biological function has remained unknown.  When they removed RimK from the bacteria, they were not able to move properly and as a result this affected their ability to initiate infections. Spraying a plant with RimK deleted bacteria resulted in milder disease symptoms compared to when wild bacteria was sprayed on the plant. However if this bacteria were injected into the tissue of the plant, the RimK mutant bacteria were able to infect normally. Therefore RimK is important during the early stages of plant infection only.

Although, when a bacterium senses that it is in a new place to grow, such as on a plant leaf or on a human cell it adapts to that environment by changing the production of many proteins. It is the RimK that controls this change, but when the bacteria no longer make this protein they don’t migrate when they should thus the bacteria find it difficult to start an infection. This may be really useful for researchers to control an infection rather than kill the bacteria directly.

 

 

 

 

Sources: http://www.medicalnewstoday.com/releases/306100.php

The situation with Junior Doctors

The situation with Junior Doctors

What is actually happening?

Many junior doctors in England appear to be quite outraged by the release of example rotas that demand they work both Saturday and Sunday up to 3 weeks consecutively. In spite of a guarantee by Jeremy Hunt (Secretary of State for Health since 2012) to never press them to work this many weekends successively. Not only can this lead to exhaustion of the junior doctors, for instance by suggesting they must work for 48 hours straight on some weekends. This prompts fears among junior doctors that they may be required to work longer hours. On the other hand Mr Hunt contradicted what he stated in a previous speech where he claimed that “the maximum number of consecutive long days will be reduced from seven to five; and no doctor will ever be rostered consecutive weekends”…

Why?

The plans to change the contract arose in 2012 though this dispute began in 2014 when the junior doctors and the government disagreed on certain modifications. Ministers agreed that the doctors should receive an 11% basic pay rise, however this is counterbalanced by cuts to other elements of pay. For instance those that support unsocial hours that they may have to do. This is justified by the fact that it can create a more “7 day” service for the NHS. It can effectively make it much cheaper and easier to timetable extra doctors during the weekends.  Moreover the small percentage of doctors who already do a lot of extra hours can qualify for premium payments under the existing contract,  but are having this incentive removed and therefore will lose out.

In total there are 55,000 junior doctors in England, this represents a third of the medical work force. Many people are often misled by the term ‘junior doctor’, it doesn’t necessarily just mean the medics who have just recently graduated from medical school but it can also cover those who have more than a decade of experience in the field. These junior doctors have a major responsibility in the framework of hospital systems and the NHS, they are regularly leading teams, making life and death decisions and carrying out surgery.

Mr Hunt argues that it is mandatory to improve the health care during the weekends because a study published by the BMJ found that “those admitted on Saturdays had a 10% higher risk of death, 15% higher on Sundays compared with Wednesdays”. Although, some have rebutted that all these deaths can potentially be reduced through increased staffing as there currently are not enough doctors to cover the rotas. However with the proposal of this new and more challenging contract, could the number of staff employed diminish over time and may this spread remaining staff thinner?

“I remember walking down the corridor in the middle of the night towards the end of one of those (56 hour shifts) and talking to a person next to me who wasn’t really there. How can that possibly be safe?” Asks Dr. Ansari.

Strikes 

The junior doctors have been forced to take action and go on these strikes to send a message to the government that what they hope to impose on medics is highly unreasonable. Fortunately some strikes were called off which is beneficial to the patients because they would have had to cancel numerous operations. The doctors don’t want to put patients’ lives in danger, but these strikes occur to protect both the patient and doctor’s safety. Perhaps the government need to start listening to the doctors and try to sustainably preserve the NHS – one of Britain’s advantageous assets.

How may this affect us in the future?

This means that new doctors starting their career in the NHS under this contract may essentially be worse off than they would have under this existing deal. The starting salary for a junior doctor is currently just under £23,000 a year, but with extra payments for things such as unsociable hours, this can quite easily top £30,000. But is the pay really that great an issue? Many other fields of work may undergo economic instability and as a result some of the funds must be adjusted. With regards to what this means for us as future medics, the most important thing is that we can offer the appropriate service to the patients relying on the NHS.

In this time of need, almost half of the junior doctors finishing their foundation years are not entering the NHS. So many people have been diverted from the NHS route perhaps because all of the effort and hard work they put in is not being fairly recognised.

How we can support them?

Some suggestions made by junior doctors to show our support include:

  • Writing to our local MP to explain why we support them and ask him/her to support junior doctors in parliament. I will copy a template below which you can personalise, rewrite and possibly send to your local MP and to the Department of Health at Richmond House, 79 Whitehall, London, SW1A 2NS. (It’s very simple, I have and so can you!)
  • Using the #IAmTheDoctorWho to explain what they do.
  • Sharing stories using the #IAmThePatientWho.
  • Supporting them on various social media.

Remind yourself why it is you want to become a doctor in the first place. Despite all the political difficulties, we all have our own reasons that may go beyond the external struggles we could face. The NHS is a wonderful system that is envied by many other countries in the world because it provides everybody with an equal chance to receive great healthcare. Let’s try to maintain that.

“Dear [Add the name of your MP],

As a junior doctor/concerned member of the public.  I have a duty to speak out when patient care is compromised. The new junior doctor contract being imposed by this government will remove vital protections on safe working patterns and could see a return to junior doctors working up to 90 hours a week. With the best effort and will in the world, they cannot be held responsible if such dangerously long hours put patients directly at risk.

The new contract will also impact on patients because it will lead to an exodus of highly-trained professionals out of the NHS and into jobs or to countries where they will be better respected and rewarded. Over the last decade, our job conditions have been gradually eroded by pay freezes, banding reductions, pension cuts, poor workforce planning, and the removal of free hospital accommodation.

None of us goes into the profession for the money but out of an innate desire to help save and improve lives. But the years of studying, training and acquirement of expertise, on top of the financial debt and personal sacrifices, do need to be fairly reflected in our pay. The basic full-time salary for a newly-qualified doctor is now £23,000. If the government impose the new contract, which reduces junior doctors’ pay by around 30%, then doctors who have graduated with well over £50,000 of student debt will be earning less than the national average.

Those who do not leave can be expected to fight the new contract which is not only unfair but unsafe. This may well mean strike action. At a time when the NHS is already under threat from under-funding, rationing, and creeping privatisation, both an exodus and a strike pose serious threats to the stability of the system. Either could have grave consequences for patient care. We call on the Health Secretary Jeremy Hunt to intervene as a matter of urgency and withdraw this ill-judged junior doctor contract and prevent what is likely to be vote for a strike for which he bears ultimate responsibility.

Yours sincerely,”

 

Sources:

http://www.independent.co.uk/news/uk/politics/junior-doctors-furious-after-new-example-rotas-show-them-working-three-weekends-in-a-row-a6882541.html

http://www.bbc.co.uk/news/health-35352911

http://www.theguardian.com/society/live/2016/feb/10/junior-doctors-strike-second-24-hour-walkout-over-new-contracts-live-updates

 

My Experience at Medlink Campus – University of Nottingham. Saturday 12th December 2015 – Tuesday 14th December 2015.

On Saturday the 12th of December 2015 I embarked on the 4 day experience of a lifetime, I had heard from others about how beneficial Medlink Campus is but this was the time for me to experience it for myself. I must express that it was truly life changing event in many ways. For instance I was able to have a short preview of University life at Nottingham by attending very extensive lectures and the information I gained from which shall go a very long way in my medical career. Including some stimulating late night debate sessions that brought up some intriguing and challenging subjects. In addition to this I was able to meet a plethora of exciting, interesting and likeminded people all determined to succeed in medicine and engage in meaningful discussions each day. It must also be said that the friends that I made during these four days have become some of the closest friends I have and I think we will continue to support each other in the path to medicine.
 medlink2

DAY 1

On the day of arrival, after all the formalities had been completed, we attended the initial lectures that describe the different types of medicine that we could choose to enter. For example paediatric medicine or surgery, delivered by distinguished medical professionals. The key information I gained from these is that this paediatric medicine is intellectually challenging and demanding as it can be quite family orientated and a lot of skill is required to communicate with frightened parents as well as having the ability to connect with children. There is such a variety in the types of speciality of paediatrics and the role of the doctor is not only that during the appointment but they must always have the child’s best interest at heart. The lecturer stated that it is a privilege to work alongside the families, the rewards are very real and that no two days are the same in this exciting environment.

The following lecture detailed the applications and training for a career in surgery. It was extremely interesting to hear the lecturer’s point of view of the surgical profession. She provided us with an important and influential quote from Confucius that states to “choose the right profession, you won’t work a single day”. Following this we were given some extremely valuable advice about medicine and social media from an immensely exciting and engaging speaker. In a world in which technology is becoming ubiquitous, we future doctors must be aware of our social profile and the potential services we can provide to others.

Following this, we were all involved in a group discussion and this lead to an intriguing debate in which we learned to question all aspects of ethical situations and develop our opinions and understand different views. 

DAY 2

On the second day, we were provided with information about foreign university opportunities from a surgeon at the Humanitas University, Milan. This was very eye opening to be exposed to the possibilities of medicine outside of the UK.

Moreover, a crucial section of succeeding in University application to medicine is having the knowledge and capacity to achieve highly in the interviews. As a result I found the interview workshops very informative as I had realised many things about the process that I had not known previously such as the types of interview and how they differ. Some of the advice from this includes being able to use the interview as an opportunity to decide if the medical school is actually for you. It is always essential to show curiosity and have questions prepared for the interviewer. The most important thing is to be ourselves and say what we honestly believe rather than what we think the interviewer wants us to say. We then experienced a live interview, what not to do and a question and answer portion to clarify any of our doubts.

Subsequently we had the Clinical skills section of the day. We separated into our small groups to have an auscultation session, ophthalmology and patient clinic. Auscultation provided us with an insight into how to use basic instruments such as the ophthalmoscope, the otoscope and the stethoscope with our peers. We learned some of the sounds, features to recognise when giving an examination and I left this session very excited to use my stethoscope more often! The patient clinic was somewhat challenging, despite having studied the information given beforehand, trying to deduce the condition of the patient by knowing how to ask the right questions while retaining some of the patient’s relevant history to reach a conclusive diagnosis was not particularly simple.

Following this we had an interview workshop, which highlighted how we can aim to perform our best to leave an effective impression. Something that remains with me now is that we must have a realistic idea of Medicine and what we intend to pursue in the future. Moreover we shouldn’t display any prejudice or unethical views towards the topics covered and it is advised that we can think clearly around the tasks given. This advanced into the Multiple Mini Interview practical in which we were placed in small groups to work together in answering some possible questions while feeding back to the larger group.

The later lectures informed us about general practice, the UKCAT update, medical school admissions, studying abroad and an animated talk about prehospital care given by an RAF Medical officer.

Once all lectures and debate sessions had finished, our hall had an open common room and mix evening to allow us to talk with many new people and have quite profound and interesting conversations.

DAY 3 

This was the Exhibition day. A unique opportunity to ask the fundamental questions to a myriad of medical universities both international and those in the UK. Many universities have different methods of teaching the Medicine course and each one has its own character which is important to note. When we eventually decide on the university we wish to apply to we need to be sure what the University has to offer, whether the curriculum is suitable for us and if the admissions guidelines are appropriate for our abilities as individual applicants.

During the evening I was able to secure an opportunity to have a mock MMI interview. In my experience I had very positive feedback from my interviewer, I attempted to calm my nerves and use the advice given from the previous day as much as I could. I was enthusiastic and the interviewer said that he became more interested as a result. In reflection, I feel that I could have improved it by speaking a little slower and this may have given me more time to craft my sentences effectively and speak more clearly.

We then began the Pathology section later that evening by some talks about Cancer diagnosis and treatment. The specific details and statistics from this talk reinforced some knowledge I had about cancer, although hearing the views of a doctor who had dealt with many cases brought the facts into a reality of the difficulties they face. Though the treatments available, may be slightly intrusive and challenging, the medical professionals find it gratifying to aid others and remain on the cutting edge of scientific research.

Later we were introduced to the careers and opportunities in pathology, by exploring microbiology and bioterrorism and the history of biological weapons and the measures being taken to protect the population against this.

DAY 4

The last day was focussed on gaining an understanding of the different components of Pathology.

The Autopsy lecture informed us that the reason people carry out autopsies is to confirm the presence and nature of a disease and to ascertain the cause of death and create health statistics and epidemiological data. We were introduced briefly to what an external and internal examination entails and the benefits that an autopsy has for society and many of the people involved in the case. This lead to the extremely interesting talk on forensic pathology and the requirement for combined disciplines such as radiologists, toxicologists, neuropathologists, microbiologists and even archaeologists.  The final lecture explained the nature of the Haematology profession and how it can be an integral part of diagnosis and treatment of a variety of diseases. Although they may face certain ethical complications, for instance in the case of stem cell therapy or bone marrow transplants, it is very interesting to find out more about a vital function of the fascinating human body. I was also pleased that the lecturers were open to questions following each session, in this way we were able to gather more of an insight into the work they are involved in.

One of the many advantages of attending Medlink is that we have the chance to undertake a research project related to Genetic Engineering.  This aims to extend and develop our A level studies and allows us to reach beyond the confines of exam syllabuses. We effectively need to choose an area of genetic engineering, carry out some extensive research and possibly design some experiments for a GMO. Then eventually write a short scientific paper exploring the factors we are most interested in. I am personally very excited about delving into this area of science!

Overall, these few days were immensely informative and motivating, I now think I am better equipped to apply for a Medical degree. I left Medlink having gained a lot of knowledge into the application process, the vast number of specialties I could enter and the many ways in which I can broaden my skills and interests. I am now feeling more positive and confident about Medicine as a career for me and I am keen to see what the future holds. If you ever have the opportunity to attend any of the Medlink conferences I definitely recommend you do!

Biggest challenges facing medicine over the next 50 years – an important factor to consider when entering this field.

In the next 50 years the world as we know it may transform into an unrecognisable state of continuous development that we potentially cannot cope with. On the other hand medicine may remain comparable with the way it is now. There is no method of predicting the path we may take, but the next 50 years involves today’s generation of prospective medical students, so these challenges will influence us the most. It is important to consider how modern life may evolve, but initially we must observe how past medical difficulties were overcome.
    During the past century advances in science and engineering were applied to many medical problems. In the 1800s doctors developed the first instruments to examine and understand the body such as the stethoscope or kymograph1. The astounding reduction in infant mortality and hygiene improvements by the influence of Lister and Semmelweis have also transformed medicine. Furthermore many of the revolutions such as the discovery of penicillin, psychiatric improvements and transplants were preceded by extensive phases of trial and error before eventual successes2
. The origin of the great challenges of the past may be due to insufficient knowledge since scientific understanding of metabolic processes and the level of available technologies were not as sophisticated as they are today. Nevertheless, medical practitioners were pioneering in understanding the body and finding solutions.
    In addition, a potential issue facing future doctors is meeting patient expectations. Many patients think there is a doctor waiting to immediately see them once they arrive at the A&E.  This isn’t the case and promotes aggravation and anxiety to the patient and his/her family.

    So, what might patients expect from doctors in 50 years?

The roles of GPs are ever changing, despite many of them working at the limit of their ability with constantly rising demands and requests. Also, updates, studies, appraisals, revalidations and communication add to their workload. Perhaps they may be expected to spend more time, take on more patients with our expanding population or possibly offer multiple services to deal with the emergence of new conditions.
    “Technological advances may begin to undermine the valuable role of medical professionals3.” Undoubtedly without the large pharmaceutical companies we could not have created and tested many of today’s most significant drugs. Two factors that make drugs important are that they treat a large number of people with diverse complications and they have led the way to treating diseases. However in 2014/15, the MRC spent a total of £771.8m on research4
. Perhaps we can question the necessity of medical research as there could be alternative treatments instead of prescription drugs. Similarly there must be a limit to the number of chemically based new drugs. The funding for this research can arguably be distributed in other ways, by relieving poverty in the less developed countries for example. Given the importance of other global problems research may not be as valuable as practical aid.
    Scientific knowledge is growing exponentially and the rate at which we discover gene variants for common diseases is increasing. Moreover “knowledge reorients the entire medical system5”. Coupled with technological advancements and genetic sequencing techniques, the way in which patients are diagnosed and treated can become dependent on each person’s genetic composition. Allegedly medical knowledge is doubling every eight years, so potentially for students who will graduate in 2020, the information they acquire in the “first 3 years of medical school will be just 6% of what is known at the end of the decade6
”. Therefore if this intelligence develops much faster than our ability to understand it effectively the most important skill we must adopt is to identify the suitable information for the right situation.
    With the inevitable technological advances, the arrival of personalised medicine raises ethical concerns. Personalised medicine involves tailoring disease prediction, prevention and treatment to each patient’s unique genome7. Therefore the patient can be prescribed a bespoke combination of specific drugs / treatment programme, in contrast to the present day in which most similar conditions are treated in the same way. In effect, the 100,000 Genomes Project could, when completed, provide a new genomic medicine service for the NHS8. On the other hand, it is essential to study the impact of genomic screening with safety in mind.

Is the medical benefit to a child, with a possible removal of a genetic disease, greater than the harm of removing the child’s autonomy?
    Expanding antibiotic resistant bacterial strains is a major concern for human health. In 80 years since penicillin was discovered, antibiotics have been overused and bacteria are pressured to develop resistance. The challenge of increasing bacterial resistance is a combination of what is discussed above, therefore is the greatest challenge to medicine in the future. Moreover, “in the EU 5-12% of hospital patients acquire an infection during their stay with 400,000 having the resistant strain9.” This resistance is spreading quickly, due to more travel and unnecessary use of antibiotics e.g. agriculture. New resistant mechanisms are emerging with Escherichia Coli as in China in 2015 where Colistin, the last resort drug, was ineffective10. With regards to patient expectations, a clinician often is pressured into prescribing a broad spectrum of antibiotics patients by acting quickly on incorrect information. However we are limited in terms of biomedical advancements as we haven’t yet found “new antibacterial substances since the 1980s11”. Serious complications ensue if antibiotics cannot destroy bacteria such that simple infections can be lethal. In addition to this with a rapidly growing knowledge, our chances of eradicating the resistant strains may rise.
     “Wherever the art of medicine is loved, there is also a love of humanity (Hippocrates)”. Despite the prospect of future medicine in 50 years appearing to be intimidating, medicine always has a profound purpose in society. It is important to remember that as humans we always seek to improve our situation and practitioners always endeavour for the best interest of the patient. Occasionally we may struggle to find a solution, however with deeper knowledge and preparation, we have the power to overcome these challenges.

 

The links to the references used in the preparation of this blog are given below.

  1. http://www.sciencemuseum.org.uk/broughttolife/themes/technologies.aspx
  2. Book title: The rise and fall in modern medicine, by Dr James Le Fanu.
  3. Biological Sciences Review journal link: http://my.dynamic-learning.co.uk/ViewPage.aspx?tid=5406f457-b9fc-47ec-8814-90d21a1d2a90&fn=dps0026-0027.swf&i=f20ae2ad-af22-4e07-8c11-3213e81665ee&baseTitleID=1825&r=true&vle=true&minPage=26&maxPage=31&searchText=future of medicine
  4. http://www.mrc.ac.uk/about/spending-accountability/facts/
  5. https://www.jimcarroll.com/2011/10/trend-the-future-of-knowledge/#.Vo7b06SzV9Q
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116346/
  7. https://www.futurelearn.com/courses/the-genomics-era/2/steps/48237
  8. http://www.genomicsengland.co.uk/
  9. http://themunicheye.com/news/A-Sweet-Deal-for-Antibiotics-3173
  10. https://www.newscientist.com/article/dn28633-resistance-to-last-resort-antibiotic-has-now-spread-across-globe/
  11. http://sciencenordic.com/what-are-major-challenges-modern-medicine