Drug reps in hospitals offer free lunch's, cheap pens and goodies to doctors in hospitals. They usually appear once or twice a week. Something about this form of advertising just doesn't sit quite right with me. I haven't really thought deeply enough about the subject to come out with an eloquent answer when asked why I don't touch the food provided by the drug reps during some 'grand rounds'. I should, and I imagine I probably will at some point. I understand why drugs are advertised, but I also think that medical practice and treatment should be guided purely by what is the best treatment for the patient, and not necessarily guided by advertisement of the latest drugs. I think, as humans, whether we realise it or not, are affected by gifts. Someone does you a good turn/gives you something, you can't help but a feel indebted. I just feel that feeling is badly placed when it comes to commercially orientated companies.
The 'no free lunch' position is explained in these websites: (US version and UK version) better than I ever could.
For good evidence:
UK - drugs and therapeutics bulletin
Canada = therapeutics initiative
US - The medical letter
Sunday, April 29, 2007
Friday, April 27, 2007
I confirmed a death for the first time today...
I've been avoiding this for so long. It's strange how a person can become so still, how their eyes have this vague opaque haze, how that unusual silence on the other end of the stethoscope means you hear your own breath and wonder momentarily if it's their's, how the quiet pulsations of your own fingertips transmit up and make you wonder if their heart is actually still beating. Disconcerting. I wanted to run away. I didn't. I came away thinking of kids in war zones and famines. I hit google looking for solace and guidance. I found an article in the BMJ.
I don't want to do it again. But I know I will. I know I will eventually get used to it. I don't know whether that's a good thing.
And so life continues...
I don't want to do it again. But I know I will. I know I will eventually get used to it. I don't know whether that's a good thing.
And so life continues...
Sunday, April 22, 2007
Poem: I AM A GIRL OF THE 21st CENTURY
During the storm I create Peace in my soul
I close my eyes until the storm is over
Like an eagle I try each day in my life
To reach where my heart is.
Hope that I have inside, to give me
Strength to be what I want to be
I let no one harm my soul
I always focus on my future.
During the night I dream about freedom
During the day I build happiness in my soul
Each day I shape my life.
Trying my very best to do only the right thing.
I am born to be bold and brave
To have faith in everything I do
To help those who are being criticised everyday
To renew hope in their lives.
Even if it may seem to dark
My heart will lead me to a place of Peace.
I am living for tomorrow.
Not for today
Only because
I am a girl of the 21st century
Zandile Sylvia Mazibuko
I close my eyes until the storm is over
Like an eagle I try each day in my life
To reach where my heart is.
Hope that I have inside, to give me
Strength to be what I want to be
I let no one harm my soul
I always focus on my future.
During the night I dream about freedom
During the day I build happiness in my soul
Each day I shape my life.
Trying my very best to do only the right thing.
I am born to be bold and brave
To have faith in everything I do
To help those who are being criticised everyday
To renew hope in their lives.
Even if it may seem to dark
My heart will lead me to a place of Peace.
I am living for tomorrow.
Not for today
Only because
I am a girl of the 21st century
Zandile Sylvia Mazibuko
Wednesday, April 11, 2007
Tuesday, April 10, 2007
For a warm and fuzzy feeling...
The Toronto Star (Toronto's paper) has a section called Acts of Kindness - where people send in nice things other people - often random strangers - have done.
Would be nice if every paper did that...
Would be nice if every paper did that...
Monday, April 09, 2007
Saturday, April 07, 2007
MMC resignations...
It's not just the students going through the process who are unhappy with the system - so are the people who set it up and were contributing to running it.
Resignations seem to be propping up left, right and centre. To be fair, those resigning are the ones who were probably doing their best to improve a system. Just a shame it didn't work out.
The latest is from one of the student representatives - his letters are a good read and summary of the situation:
letter of resignation, as sent to Professor Crockard 18/03/07.
Dear Alan,
I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.
When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.Now as then (when I presented you with a petition signed by 1300 students), I believe:
• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school
Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.
In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.
I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.
Yours Sincerely,
Alex
letter as sent to the CMO 31/03/07:
Dear Professor Sir Liam Donaldson,
I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.
From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.
Yours Sincerely,
Alex Liakos
(picked up from the lost doctor)
more news on mmc
Resignations seem to be propping up left, right and centre. To be fair, those resigning are the ones who were probably doing their best to improve a system. Just a shame it didn't work out.
The latest is from one of the student representatives - his letters are a good read and summary of the situation:
letter of resignation, as sent to Professor Crockard 18/03/07.
Dear Alan,
I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.
When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.Now as then (when I presented you with a petition signed by 1300 students), I believe:
• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school
Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.
In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.
I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.
Yours Sincerely,
Alex
letter as sent to the CMO 31/03/07:
Dear Professor Sir Liam Donaldson,
I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.
From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.
Yours Sincerely,
Alex Liakos
(picked up from the lost doctor)
more news on mmc
Friday, April 06, 2007
Poem: SONG OF THE GALLEY-SLAVES
We pulled for you when the wind was against us and the sails were low.
Will you never let us go?
We ate bread and onions when you took towns, or ran aboard
quickly when you were beaten back by the foe.
The Captians walked up and down the deck in fair weather
singing songs, but we were below.
We fainted with our chins on the oars and you did not see
that we were idle, for we still swung to and fro.
Will you never let us go?
The salt made the oar-handles like shark-skin; our knees
were cut to the bone with salt-cracks; our hair was stuck
to our foreheads; and lips were cut to the gums, and
you whipped us because we would not row.
Will you never let us go?
But, in a little time, we shall run out of the port-holes as
the water runs along the oar-blade, and though you tell the
others to row after us you will never catch us till you
catch the oar-thresh and tie up the winds in the belly of the said. Aho!
Will you never let us go?
Rudyard Kipling
Will you never let us go?
We ate bread and onions when you took towns, or ran aboard
quickly when you were beaten back by the foe.
The Captians walked up and down the deck in fair weather
singing songs, but we were below.
We fainted with our chins on the oars and you did not see
that we were idle, for we still swung to and fro.
Will you never let us go?
The salt made the oar-handles like shark-skin; our knees
were cut to the bone with salt-cracks; our hair was stuck
to our foreheads; and lips were cut to the gums, and
you whipped us because we would not row.
Will you never let us go?
But, in a little time, we shall run out of the port-holes as
the water runs along the oar-blade, and though you tell the
others to row after us you will never catch us till you
catch the oar-thresh and tie up the winds in the belly of the said. Aho!
Will you never let us go?
Rudyard Kipling
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