Medical blogging -- what's your opinion?

It's time to overcome that summer lethargy and reclaim the work ethic! AJ and I are giving a presentation at the Medical Humanities Conference, hosted this year on 4 and 5 September by King's College London. We're talking about ... medical blogs. It seems sensible to sound out our esteemed readership by asking your opinions on the ethical issues facing medical bloggers. Is it fair that doctors can reveal nothing of their patients yet patients can say whatever they like about their doctors (as long as it's not libellous)? Should doctors be giving medical advice in their blogs? Are there any specific blogs you can recommend as being particularly good? We'd love to hear from you on these or any other issues pertaining to medical blogging.

Closer

'A Clinical Observer of the Human Carnival'

I've just seen Closer, starring Natalie Portman, Julia Roberts, Jude Law and Clive Owen. It's a film about the superficiality and need of human relations, played out with adultery and lust between two couples.

Clive Owen plays Larry, an emotionless, carnal dermatologist, who is unembarrassed to pursue what he wants, ruthless in his approach. He is countered by Dan, played by Jude Law, a novelist and journalist. Ultimately, Larry's unfaltering ruthlessness wins over Dan's romantic weakness - the alpha male succeeds in his primeval nature.

I was interested to note the themes of science versus literature, medicine versus humanities, clinical detachment and male versus female. The characters' roles in their lives - a photographer, dermatologist, stripper and waitress - all represent the superficial; all apart from Dan, whose book fails, meaning he must return to writing obituries - which are prewritten, again representing superficiality. His attempt at genuinity fails as he bases his book on another, without searching it out for himself.

Closer is a great film, very gritty, realistic and raw. There are some brilliant performances by a great cast, and it is another example of a mainstream film which manages to catch some of the age old issues in medicine.

Pieces of April

I've just watched Pieces of April, starring Katie Holmes and Patricia Clarkson, directed by Peter Hedges (of What's Eating Gilbert Grape and About A Boy fame).

I was really taken with the character of April's mother (the role for which Patricia Clarkson won Best Supporting Actress at the Golden Globes and Academy Awards in 2003). She brings to life the persona of the mother who doesn't get on with her estranged daughter: post bilateral mastectomy for breast cancer, April's mother is searching for morsels of love and happiness in her disastrous mother-daughter relationship.

The film sees the family (naive father, cynical, badly behaved mother, demented grandmother, pot-smoking brother and goody-two-shoes sister) assemble to visit April in New York on Thanksgiving. The day is clearly set to be a shambles from the word go; this isn't helped by the mother's negativity towards the plans, her behaviour that everybody tolerates as she's ill, and April's various setbacks in preparing the meal.

It's difficult, as the film is about April, but for me the character of the mother took over; there is even a scene, in the car ride to lunch, where Joy, the mother, shows her own mother some photography (taken by April's brother Timmy), of her cancer experience. We see pre and post-op photos. We also experience her nausea at several service-stations along the way. We see her adjust her wig, her fragility.

The film gives a good insight into how someone, cynical and stoical, faces the unhappiness in their life at a time when it's beginning to be too late to be able to do anything about it.

Smiley - the antidepressant perfume

In Selfriges on Saturday some PVC-clad blondes dressed as nurses caught my eye. They were brand communicators for a new perfume by the name of Smiley. It's from designer Ora Ito, and claims to be the world's first antidepressant perfume. Unfortunately I didn't sniff any - I was in a good enough mood from having played with Apple's distorting webcam software that had friends and I in fits (think hall of mirrors).

This is the blurb from the official website:

Prescription free happiness, now available?! Smiley offers a unisex and universal range of products with micro-nutrients to activate happiness! Its secret: the formula is based on natural bio-chemistry combining theobromine with phenylethylamine derived from pure cocoa extract. This psycho stimulant cocktail is available in a whole range of preparations using galenical pharmacology. A 100% medical look for a unique therapy, the range is revealed out of the confined box of the luxury perfume industry! This antidepressant remedy is to be consumed without any moderation: in the shower, in the bath, for specific use anytime you wish! The formulae are preserved in exclusive perfume bottles developed by the prestigious glassmaking techniques of Saint-Gobain and desinged by Ora-Ito, the most sought after designer of his generation. Nothing like it to contain the happy therapy!

Medicine has never been so fashionable since the demise of Damien Hirst's The Pharmacy restaurant. Frankly, it seems a little bizarre, stigmatising itself somewhat by making its purchasers appear depressed. What do we think?

Snakes On A Plane

I've just been to the cinema to see Nacho Libre - very amusing. I also saw a trailer for Snakes On A Plane. I thought I'd mention it here as its tagline is very psychiatric, involving agoraphobia, claustrophobia, aviophobia and ophidiophobia. However, it looks pretty terrible (the plot involves an assassin trying to kill a witness on board a plane with a time release crate of snakes - hmmm). Reviews welcome from anybody interested.

In Shadow

I've just finished my first clinical attachment of the final year. Otherwise known as 'Professional Work Experience', I shadowed a Pre-Registration House Officer in Respiratory Medicine. I loved it. Despite the huge amount of paperwork and the errand running, for the first time I really felt part of the team with whom I was attached.
I'm finding with increasing frequency this year that the approach to students, now in their final year, has changed. We are treated more as equals, and thanks to the fact we are more able ourselves, we can make a bigger contribution. Even small things like going for lunch with the Registrars - virtually unheard of in my past experience - happened every day.
The practical day-to-day things, such as writing up fluids, dealing with patient's electrolyte balances, writing up drug charts, ordering investigations and requesting a specialist's opinion may sound mundane, but bring an increasing confidence and provide the opportunity to even out the workloads on the ward doctors.
We were lucky to have a Physician's Assistant on our ward, which we shared with another team. Their role is to help with recording blood results and other investigations, which frees up the doctors to spend more time with the patients. It's that last half an hour of the day when one is keen to get home that gets freed up with this system.

Interestingly, I found I got further introducing myself as a Student Doctor rather than a Medical Student. This studentBMJ article looks at the differences in this approach. As the article points out, this can lead to patients believing you really are a doctor. I have to admit, many of our patients did think I was a doctor, and I did nothing to correct their mistake. It was nice to experience the position, and interesting to note any differences in the way I was treated by the patients. Obviously I didn't use this to do anything I shouldn't have (I'm allowed to write prescriptions, for example, but they must be checked and signed by a doctor) but I, for one, will continue to introduce myself as a student doctor.

I also learnt of a consultant's blog during my time. It seems fairly commonplace for healthcare proffesionals to document their experiences or have some form of outlet for the frustrations of work.

Finally, after my pleasant summer holiday and the haze of revision prior to that, it was strange to experience death again. I found myself totally unfazed by the two corpses I saw - one on the first morning, and one again on the last. Walking onto the ward, introducing myself to the House Officer and then certifying somebody dead a minute later was a strange experience, but I wasn't emotionally unaffected. I didn't know this patient, but I did know the lady who died on my last morning. She had terminal metastatic breast cancer, antibiotic-associated diarrhoea and a chest infection. She was not for resuscitation. She was isolated in a side room, and had requested to be 'allowed to let die'. I felt somehow my time was completed by her death, it provided some sort of closure. And I felt happier, knowing her suffering had ended.

Next I'm doing Anaesthetics and Pain Management. I'm looking forward to learning how to intubate somebody. I've always been intrigued by anaesthesia, and I'm keen to learn the skills necessary for basic life support. I'll keep you informed.

Update

Thanks to everyone who came along to discuss Ian McEwan's 'Saturday' on Thursday evening. The discussion, as usual, widened out to a very interesting purview of medicine in novels in general, went off on a tangent to discuss film versions of books, and also detoured into how honest medical students should be about practising on patients. As far as 'Saturday' was concerned, the consensus seemed to be that the level of research into neurosurgery was impressive but slightly ostentatious in the narrative, which some found irritating. Next month (Thursday 7 September) we'll be discussing 'The Moviegoer' by Percy Walker. Everyone welcome.

I've been abroad for a bit, so the TV and radio listings in the sidebar have been languishing, but they're now up to date. Of note is that it's 'memory month' on the BBC which means a swathe of radio and TV programmes are devoted to memory and it's problems. Full details here.

Guilt

It's not just the Catholics who carry the sins of the world with them. Future docs do it too.

This morning's episode saw yours truly getting on the Hammersmith and City line. Holding the handrail positioned by my seat, was a lady with Downs' Syndrome, aged thirty-five or thereabout.

This lady was shaking her head & talking aloud in a most irritating manner. She'd have been less tiresome if I'd not had a Sudoku to be getting on with.

The rest of the passengers moved on to sunnier, more peaceful climes within our carriage. Muttering and tutting, mothers grasped their healthy children tightly against their forms. I tried my utmost to be understanding, wondering whether it would indeed be appropriate to tell the aforementioned lady to respect the peace. Being obnoxious is not exactly a symptom of her condition, so why should the rest of the carriage have made allowances for it?

Three minutes went by before the lady found herself with 75% of the carriage to herself. My frustration had grown significantly, to the point of wondering whether it was worth my time to continue with another three minutes of frowns and steely gazes. I also wondered whether I'd be considered 'evil' and 'intolerant' for asking her to quieten down.

I eventually gave in and moved, pondering whether society is too lenient on those espousing the 'sick role' or not. Abdication from responsibility is acceptable to a point, but the point where these responsibilities are acts one is not hampered from participating in needs to be defined.

What would you have done?

Japanese Drug Advertisements

This is just one example of the many Japanese drug advertisement images that are available here at the Japanese Gallery of Psychiatric Art. The online gallery shows Japanese drug advertisements from 1956-2003. You can read the official press release for Lullan (the example above) here. Life certainly looks idyllic on anti-psychotics - if you believe the adverts that is.