Sunday, November 24, 2013

Saturday, November 23, 2013

S.W.O.T.



'This song was written by 4th year medical students from Queens University Belfast. Our society SWOT (Students Working Overseas Trust) is a charitable society run by the 4th year students that raises money every year, which we hand-deliver to 3rd world hospitals on our 4th year electives.

The song sums up what our society is about, and it's a new way for us to try and raise funds for those who need it most. We hope you enjoy it, its pure cheese, but its been great craic to make! Please give us a share on facebook or twitter to help us spread the word and get as many downloads as possible. It's available on iTunes, Amazon and Spotify, and many other online stores!

Watch this space, we are about to launch our new website too, so you'll be able to learn more about our society! We are always looking for donations and sponsors, feel free to contact us on swot@qub.ac.uk

The band:
Jonny McDowell - Lead guitar and vocals
Alana Spence - Vocals
Sean McNicholl - Rhythm guitar
Michael McKee - Drums and rap
Luke ward - Bass and vocals

Huge thank you to the following people
Audio recorded at - Einstein studios http://www.einsteinstudios.tv
Video filmed and produced by Four Creatives - http://www.fourcreatives.com

See our other awesome sponsors in the video.

Buy the song on iTunes, Amazon or Google play - https://itunes.apple.com/gb/album/thi..., http://www.amazon.co.uk/This-Is-Swot/..., https://play.google.com/store/music/a...
spotify:album:1EQv8eREwnWMKjm5hOVPFU'


http://www.youtube.com/watch?v=M7Cdnf2AbRg


I have no direct link with the above - found on Clare Gerada's twitter (immediate past president of Royal College of General Practitioners). Really good idea for charity distribution as medical students can often go to quite remote places for the electives.

Wednesday, November 13, 2013

doctor patient relationship

http://well.blogs.nytimes.com/2013/11/11/doctors-boundaries-with-patients/

Hard Cases

When Healers Get Too Friendly

  • Alex Nabaum
    Hard Cases
    Dr. Abigail Zuger on the everyday ethical issues doctors face.
    It takes only a moment to step over the line, especially when no one knows exactly where the line is. In my case, it started with a visit from my old friend the activist.
    The activist became my patient back in the mid-1990s, when H.I.V. was slowly morphing into a treatable disease. He was young then, with a mop of dark curls — excitable, suspicious and frantic about his health. He was convinced the new drugs were pure synthetic poison, a profiteering scam by the government and Big Pharma. He was also feeling sick enough that he thought he might just give them a try

    He lurched back and forth between these two incompatible positions once or twice a month, dragging me and my prescription pad behind him in a flurry of abandoned amber plastic bottles. Eventually, though, good sense kicked in and he had to admit that on meds he felt a lot better than otherwise. He managed to retain his contempt for the system while regularly filling his prescriptions. I no longer winced at his name on my schedule.

    And now it is suddenly decades later, his H.I.V. has long been perfectly controlled, and he is still fomenting revolution. He used to march and holler; now he works social media with a miserable old desktop computer that keeps breaking down.
    As it happens, about a week before one of our infrequent appointments — he barely needs me any more — I had treated myself to a brand new laptop, sending an old perfectly good model into the back of the closet.

    Of course I wiped its hard drive clean and gave it to him — for he is my old friend. But (also of course) we met furtively in a back corridor and I carefully concealed the contraband in a nest of old grocery bags — for he is my patient, and gifts to patients …well, we don’t usually do that.
    Once again, apparently, we were dealing with two incompatible positions. Everyone knows that professional boundaries guide all medical activity in hospital, office and clinic. But aside from indisputable sexual and financial depredations, no one agrees exactly where these boundaries lie.
    Kindness to friend and duty to patient: Are they one and the same? Or separated by a barbed-wire fence? Opinion is all over the map.

    At one extreme is the position probably best articulated by one of medicine’s great clinician-scientists, Dr. Donald Seldin of the University of Texas. In a 1981 talk to an audience of physicians, Dr. Seldin deplored “a tendency to construe all sorts of human problems as medical problems” and thus within doctors’ duty and purview to fix. If it isn’t “relief of pain, prevention of disability and postponement of death,” Dr. Seldin said, why then, doctor, leave it alone! He got a standing ovation.
    In the opposite corner stands Dr. Gordon Schiff of Harvard’s Brigham and Women’s Hospital, who was issued an official reprimand a few years ago for egregious boundary crossing.
    The incident that it set it off: Dr. Schiff (now 63, an experienced senior clinician) had tangled with an insurer on the phone for two hours before he gave up and handed an impoverished patient $30 to pay for her pain pills. A resident observed the transaction and turned him in. But Dr. Schiff is a proud repeat offender, whose past infractions include helping patients get jobs, giving them jobs himself, offering them rides home, extending the occasional dinner invitation and, yes, once handing over a computer.

    He was told physicians should stay away from “random acts of kindness” — an activity that may sound harmless but is quite distinct from the practice of medicine, and has its risks. Patients might get too familiar, expect too much.

    Dr. Schiff published a long rumination about the incident a few months ago (which, he reported in an interview, has elicited the email equivalent of a standing ovation). In it he considers whom, exactly, the sanctions against befriending patients are designed to protect. The patient in some instances, he concludes, but the doctor in far more. “Let’s not pretend we are imposing limits for patients rather than our own best interests.”

    Dr. Schiff draws medicine’s borders around a shared social agenda: doctors help the patient’s health by helping the whole patient. Dr. Seldin’s borders contain specific, technical tasks.
    If you think too superficially about all of this, you may begin to hear Dr. Seldin screeching like Ebenezer Scrooge: Are there no charities? Are there no social workers?

    But it’s not quite that simple. I too handed out the odd $20 bill at work without thinking much about it, until I didn’t see one patient for almost a full year afterward — and she was a sick person who really needed care. What had happened? “I couldn’t come back without your money,” she said.
    So that was a random act of blindness on my part, good evidence of the perils of the terrain and the need to think before each step. I think — I hope — the activist and I understand each other a little better than that.
    A version of this article appears in print on 11/12/2013, on page D6 of the NewYork edition with the headline: When Healers Get Too Friendly.
     
     
     

    From the Editor's Desk

    Martin B Van Der Weyden
    Med J Aust 2002; 177 (9): 465.
     
    The Boundaries of Medicine
    At the 1981 meeting of the Association of American Physicians, the presidential address, "The boundaries of medicine", by Donald Seldin, received a standing ovation.
    In his address, Seldin argued that medicine is a narrow discipline with the clear goals of ". . . the relief of pain, the prevention of disability and the postponement of death by the application of the theoretical knowledge incorporated in medical science". He further noted that this notion of medicine is quite distinct from health as formulated by the World Health Organization, namely "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Seldin believed that "such realisation of happiness, inner tranquility, moral nobility, and good citizenship" was not solely a matter for medicine, but for individuals and their communities.
    Today, the attainment of health and happiness is paramount, and Seldin's boundaries of medicine have become blurred.
    Patients are now "health consumers" served not by doctors, nurses or other professionals, but by "healthcare providers". Medicine is played out not in hospitals or practices, but in "healthcare systems". Indeed, policymakers propose that the antiquated terms "doctors" and "nurses" be replaced by "health practitioners" and "health assistants". Increasingly, the traditional faculties of medicine have become Schools of Medicine or Schools of Clinical Practice and Population Health swallowed up by megafaculties of health and health sciences.
    Does all this homage to health matter?
    Medicine's traditions are embodied in the roots of the word — medicus ("physician") and mederi ("to heal"). Whether the boundaries of "medicine" limit it to the application of bioscience in matters of mind or body, and illness or prevention, or are blurred by the social needs of individuals and society, is problematic.
    After all, do we not practise as MB BSs, and not as BHPs — Bachelors of Health Provision?

    Malaysian politics

    http://www.themalaysianinsider.com/opinion/ahmad-fuad-rahmat/article/factors-behind-the-anti-shia-attacks

    Factors behind the anti-Shia attacks

    August 17, 2013Latest Update: August 17, 2013 08:14 am
    Ahmad Fuad Rahmat
    Ahmad Fuad Rahmat also writes for the ProjekDialog.com collective and is a member of the Islamic Renaisance Front. He works for the Centre for Independent Journalism and is a co-host for Night School on BFM Radio. He was trained in political philosophy.
    The current attacks against Shias in Malaysia are linked to four interacting factors

    1. The Syrian Civil War
    Any informed view of the current Syrian conflict will conclude that it is primarily caused by geopolitics. The interest of The United States and Israel is to dismantle Bashar Assad's regime, since it is a key strategic ally for Hezbollah and Iran.
    Hezbollah and Iran are the only two remaining forces in the region that can pose a significant threat to the occupation of Palestine and America's wider interest in the Middle East, and they also happen to be Shia.
    The claim that the Syrian conflict is essentially sectarian is therefore the projection and/or exploitation of suspicions against Shias to match the current political mood.
    This has been brewing for some time. One case in point was the 2006 Israeli invasion of Southern Lebanon (Hezbollah's stronghold) where many Sunni Muslim figureheads called for the support of Israel while smearing Shias as the greater enemy for their supposedly deviant ways.
    Hezbollah's victory, however, made it very popular in the Arab World, as it demonstrated certain courage and resolve against the Zionist occupation that was lacking among the majority of Arab governments, who often appear to be more willing to work with Israel's demands.
    But the sympathies it garnered then are certainly waning. Eminent and influential cleric Yusuf Al Qardawi openly labelled Hezbollah as the Party of Satan while calling for Sunnis to join the fight for Assad's downfall.
    Two widely-read newspapers, Ashraq al-Awsat and Al-Hayat, have condemned Hezbollah's support for Assad and their eventual participation into the civil war. In the meantime, tensions are compounded as Sunni-Shia skirmishes in Lebanon and Iraq are mutating into further confrontation and violence, heightening insecurities.
    All of the above weave together to form a sectarian narrative of the Syrian conflict which is increasingly pervasive.
    What does any of this have to do with Malaysia? Like much of the Islamic world, developments in the Middle East feature prominently in Muslim discourse. There is, for one, the inevitable historical references: the Arabian Peninsula was where Islam began, and Baghdad was where its Golden Age took shape. Egypt stands out not only for Al-Azhar University but also for where the Muslim Brotherhood - the pioneering political Islamic movement of the 20th century - began.
    The recent outrage towards the ouster of Muhammad Morsi, so strongly declared by Muslim organisations aligned to both Barisan Nasional and Pakatan Rakyat, is just one example of how strongly sentiments from the Middle East can resonate here.
    There is also a more direct connection. As of 2010, there are more than 10 thousand Malaysians studying in Jordan, Saudi Arabia, Yemen and Egypt, majoring in Islamic studies, medicine, engineering and business. This annual cycle of graduates returning from the Middle East has been in motion since the 1980s, and with it, the importation of the prevailing sentiments there.
    Sensitivity towards the Syrian conflict is therefore not exempt from the view here. While there is, rightly, much outrage against Bashar Assad's tyrannical rule, this has largely been expressed in the Middle East and Malaysia alike in sectarian terms, thereby fueling further hostility towards Malay Malaysian Shias.

    2. The influence of religious men
    Many influential ustaz have gone on record to cast Shias in a negative light. It is not surprising to see the usual host of conservatives engaging in the vilification, although the Shia case is unique in that it evokes animosity even from across the partisan divide. Even ustaz who are otherwise apolitical are partaking.
    The list is astonishingly long. It includes Muhammad Asri Zainul Abidin, Fathul Bari, Zahazan Mohamed, Zaharuddin Abdul Rahman, Aizam Mas'od, Fadlan Othman, Azwira Abdul Aziz, Abdul Basit Abdul Rahman,Abdullah Yasin and Abdullah Din among others (many of them, incidentally, are also graduates of Islamic higher education in Jordan).
    Some of their premises evoke the current situation in Syria, although for the most part they underscore doctrinal differences.
    There are of course ulama who have resisted the bandwagon. Hadi Awang's take on Syria, for example, is timely and accurate. But by and large negative sentiments are finding more appeal largely because the influence of religious personalities with access to mosques and the media.

    3. Political convenience
    The prevalence of such sentiments presents an opportunity for political exploitation: Put simply, Shias make good fictional villains to scare the Sunni Malay majority with. Christians make for convenient external bogeymen, but with Shias, fears of an "internal" threat can be stoked.
    At any rate, what we are witnessing at the moment is only the beginning. This will continue to have distinct manifestations in different contexts. Kedah is interesting to note for its longstanding Shia population (descendants of the Shia community in Melaka from generations ago who fled to Southern Thailand after the Portuguese defeated the Sultanate).
    Whole Shia villages exist today and while the occasional and minor bickering with Sunnis are not unheard of, the situation does not call for the kind of sweeping panic urged by religious authorities.
    Is it also a plot to destabilize PAS? Mat Sabu himself has claimed that it is directed toward his ouster. But it is interesting to note that the daily vilifications from so many official and unofficial quarters have not resulted to anything more than the odd finger pointing and rumor mongering.
    Moreover, it is not as if this is the first time that the Shia scare tactic is being used against the party. If much will change in the direction PAS takes after the Muktamar, it will be unlikely due to the current anti-Shia fever, which when viewed from a larger perspective is pale in comparison to the challenges the party had survived in the past.
    The fact remains that arguments for a strong state, what more one with religious legitimacy, are always much easier to sell in a climate of fear. As it stands, it seems likely and tragically that the Malaysian Shia community will be collateral damage for the political interests of whichever career politician of the week looking to boost their religious credentials.

    4. A conservative culture
    The easy answer is to point to the authorities as the force behind all religious divisions and fear mongering in this country. While there is truth to this, it is the incomplete picture.

    For one, a great deal, if not most, of the anti-Shia sentiments are stoked by Muslim preachers who are not aligned to any formal religious institutions (who one would also be accurate to identify as more PR leaning).
    Furthermore, fear would not travel so far and wide if there isn't a mass to find it convincing in the first place. We shouldn't view society as comprised solely of malleable individuals with no sense of their own agency.
    In an age of information, fear too is a choice, what more in a setting like Malaysia where power is viewed in terms of communal competition, in which the vilification of Shias is just one dimension. - August 17, 2013.
    * This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.

    http://www.nytimes.com/2011/01/28/world/asia/28iht-malay28.html?pagewanted=all&_r=0

    In a Muslim State, Fear Sends Some Worship Underground

     
    “I consider myself the new generation of Malaysian Shia,” said Mr. Mohammad, 33, using another term to describe Shiites. “My father is Sunni, my mother is Sunni. They are aware that I’m practicing a different school of thought. It’s no problem at all.”
    Such acceptance does not extend to Malaysia’s religious authorities.
    The Constitution guarantees freedom of religion, but when it comes to Islam, the country’s official religion, only the Sunni sect is permitted. Other forms, including Shiite Islam, are considered deviant and are not allowed to be spread.
    Mr. Mohammad was one of 130 Shiites detained by the religious authorities in December as they observed Ashura, the Shiite holy day commemorating the death of the Prophet Muhammad’s grandson Ali, in their prayer room in an outer suburb of Kuala Lumpur.
    There are no official figures on the number of Shiites in Malaysia, but Shiite leaders estimate that there could be as many as 40,000, many of whom practice their faith secretly.
    While sectarian divisions are associated more with countries such as Iraq and Pakistan, Islamic experts say Malaysia is a rare example of a Muslim-majority country where the Shiite sect is banned. They say the recent raid reflects the religious authorities’ reluctance to accept diversity within Islam, and was part of the authorities’ continuing efforts to impose a rigid interpretation of the religion.
    Although there had been some earlier arrests of Shiites since the National Fatwa Council, the country’s top Islamic body, clarified that Sunni Islam was the official religion in 1996, the December raid on the prayer room occupied by the Lovers of the Prophet’s Household was the first in recent years, according to the Shiite group’s Iranian-trained leader, Kamil Zuhairi bin Abdul Aziz.
    Mr. Kamil and the other Shiites who were detained in the raid have been summoned to appear before the Shariah court for hearings scheduled for March and April to answer charges that they insulted the religious authorities and that they denied, violated or disputed a fatwa. The offenses are punishable by a fine of up to 3,000 ringgit, about $981, imprisonment for up to two years, or both.
    On a recent evening, a small group of men and a handful of women with toddlers in tow climbed the three flights of stairs to the prayer room where the raid had taken place.
    A sign atop the building, which is sandwiched between a mechanic’s workshop and a small cafe on a quiet suburban street, reads “House of Knowledge.” A Koranic verse in Arabic marks the entrance.
    Inside the prayer room, the flags of Malaysia and the state of Selangor flank a red and black banner bearing the name of Muhammad’s grandson.
    As many as 100 Shiites attend prayers led by Mr. Kamil each week, although he said many Malaysian followers worship privately. “Most of the Shia are in hiding because of the oppression,” he said.
    He said some fear they will be discriminated against when they apply for jobs if it is known that they are Shiites, while others are afraid of being detained by the religious authorities.
    Some Sunni leaders have claimed that Shiites deviate from the true form of Islam and represent a “threat to national security,” according to Mr. Kamil. He said some Sunni leaders, alluding to violence in Iraq and Pakistan, have alleged that Shiite Islam permits the killing of Sunnis, an accusation he emphatically denied.
    Since the raid, the group has installed a security grill in the stairwell leading to their prayer room, where a black curtain divides the men’s section from the women’s.
    But Mr. Kamil and others attending the prayer session this evening insisted that they were not afraid to continue practicing their beliefs. “We are not in fear, but we live in difficulty,” he said.
    Calling for dialogue with the Sunni majority, Mr. Kamil insisted that Malaysian Shiites, some of whom are married to Sunnis, want to live in harmony with all other religions.
    A statement issued by a spokesman for the federal government said the Constitution guaranteed religious freedom to all Malaysians, and that the National Fatwa Council was responsible for guiding the practice of Islam in Malaysia.
    “In 1996, the National Fatwa Council issued a ruling that Sunni Islam is the official faith of Muslims in Malaysia. Under this ruling, which is enforced by Islamic affairs departments in each Malaysian state, Shia Muslims are free to practice their faith, but are not permitted to proselytize,” the statement said.
    “It would be inappropriate for the federal government to comment further on this state-based matter.”
    The Selangor State Islamic Religious Department, which carried out the raid, did not respond to repeated requests for comment.
    Harussani Zakaria, a member of the National Fatwa Council, said allowing different sects to practice in Malaysia could lead to disputes. “It already happens in some countries,” he said in a telephone interview. “We don’t want that to come here.”
    Chandra Muzaffar, president of the International Movement for a Just World, a nongovernment organization based in Malaysia, said while there may be differences among the various sects, Shiites are part of the Muslim community. “It’s just wrong to describe Shia as deviants,” he said.
    Greg Barton, acting director of the Center for Islam and the Modern World at Monash University in Melbourne, said that Malaysia’s religious authorities had adopted a more rigid approach to Islam in recent decades and that space for public discussion of religion had narrowed under the influence of “Saudi Salafism and Egyptian Brotherhood prejudice.”
    “The group that speaks formally for Malaysian Islam is a very narrow group who have taken a very puritanical approach,” said Mr. Barton. “The religious bureaucracy has become a very meddling bureaucracy. It has a very pernicious impact on religious freedom, not just for non-Muslims but for Muslims as well.”
    Mr. Barton said while there were no precise figures, there are probably tens of thousands of Shiites in Southeast Asia, most in Malaysia and Indonesia.
    Mariyah Qibti, who teaches Shiite Islam to children at the prayer room on Sundays, has experienced firsthand the two countries’ differing approaches to Shiites. Born to a Shiite family in Indonesia, Ms. Mariyah went to Iran when she was 19 to pursue Islamic studies. Two years ago she married a Malaysian Shiite, and moved to Kuala Lumpur.
    Feeding her 1-year-old son as she sat on a rug at the back of the prayer room, she said that, in contrast to Malaysia, in Indonesia Shiites could practice their faith freely.
    Despite her looming court appearance in March, she says she is not afraid to continue practicing her beliefs.
    “This is part of the risk of being followers of Shia,” she said.