Work Experience, QE Hospital

I have grown up with many joint problems, encountering numerous rheumatologists and physiotherapists. It was natural, therefore, to be curious about rheumatology as a subject area. I managed to secure a week of work experience with my grandmother's rheumatologist (I am a carer for her) at Queen Elizabeth hospital. I was fortunate enough to be in contact with the doctor in question via email beforehand, so that I could arrange to visit other departments, too.

Rheumatology
It did not take me long to realise the systematic approach to clinics run there. I was struck at how repetitive the work seemed at times, but also at how grateful patients were to receive this kind of specialist help. The patients' desires were fully taken into account: if treatment was uncomfortable, it would be changed; if they suspected a problem, tests would be done. Trust is key from both sides. After every consultation a voice recording was made about it, verifying information and suggesting treatments- this would then by typed up and sent to those concerned (namely the patients, GPs, etc). After only about half an hour on my first day, I was made aware on the hierarchy at the hospital. Every senior member of staff was also overseeing juniors, providing advice and support. I like the learning-teaching aspect.
I found out about the intertwining of social services; most common was the unemployed that were 'looking for a reason not to get back to work by coming here', wanting to be deemed not capable- even though they may well be. I found this very interesting, my mother being a social worker herself, I have an interest in this mixing with medicine. 'Saying work is harmful has no evidence, but unemployment is bad for your health...you can see that' I was told. I was made to reflect on a wider societal contact with medicine.
Most commonly occurring cases I saw, were: vitamin D deficiency (I have this, too- supplements are prescribed) and osteoporosis- I was given information handouts that patients were also given, which proved to be very insightful. I knew that I wanted to pursue medicine as a career.

Ultrasound
I was lucky enough to be taught how to use an ultrasound machine, as well as shadowing a specialist in radiology. I was enthralled by the application of physics in this specialism; able to use my A level knowledge to explain the image produced. Depo- Mendrone was used- this injection contains methylprednisolone as the active ingredient, and is a corticosteroid; it was a number of uses. Upon arrival here, I was told the reasons for using ultrasound- it is: cheap, dynamic, and live. It was also emphasised to me the importance of sharing knowledge and understanding in a hospital setting; there is a 'complex multidisciplinary team' and  many junior doctors were about and senior staff helping where possible.
Using a small (transportable) ultrasound machine was great fun; I was able to look at my own joints and was taught how to look for inflammation as a marker of rheumatoid arthritis. Fortunately, no arthritis for me!

Dermatology
The morning I spent in a children's allergy clinic here, showed me quite a different practise of medicine. I was made aware of the pressures of managerial and administrative responsibilities of senior members of staff; sitting in on a meeting about funding opened my eyes to the NHS as a business as well as a service.
On thing that particularly concerned me, was the use of paper work instead of using computer systems...'it's 2013, why can't we use computers like everywhere else?' one of the doctors remarked; I agree entirely, but this just showed me that there is always room for change. I did, also, find the constant referrals quite frustrating, as you would never see one patient though the entire process- however I realised that it was this teamwork that lead to effective management and treatment for the patients.
Witnessing consultations with children present was interesting, to say the least. It was a more complex procedure due to the number of people responsible for making decisions about the child... as well as the noise levels of certain individuals in the room. But it was obvious how much the doctors enjoyed working in paediatrics. I was left alone on a mnuber of occassions to speak to the famiies, getting to know personal stories and accounts of allergies and their lives; this was very enjoyable.
Ordering tests was a major component in this clinic. HISS (hospital information support system) and WinPath (laboratory information management system) were used frequently. But these old computer systems seemed to me, over-complicated when one universal system could be used for the entire NHS... But funding, of course, is an issue.

Fracture Clinic
My time spent here, was my favourite of the entire work experience.This was probably thanks to the incredibly enthusiastic senior orthopaedic surgeon that I was shadowing. He taught me so much anatomy and background information of patient's conditions in between consultations- I spent the whole day frantically making notes on everything I could. The passion shown was truly inspirational to me. I was shown how to interpret basic x-rays and spoke to patients about their various conditions. He was giving me a day in the life of a medical student- lectures and shadowing and tutorials all in one. This day alone assured me that studying medicine would be the best choice of my life.
Here, I was also displayed the gratitude of the doctors toward the nurses; they seem to be an irreplaceable part of the team, doing so much of the groundwork.  It was highlighted to me, the new pressures that an ageing population is putting on the NHS- would more doctors need to go into fields such as geriatrics and in the future? There is a 25% chance of me living to 100. And 20 000 neurones are lost per day after the age of 25!

My time at the hospital did nothing but confirm my passion for medicine as a vocation. I gained so much knowledge of day-to-day life as a doctor and met real patients to discover their own stories. I am just so looking forward to studying at university! (Hopefully).

The Rise and Fall of Modern Medicine

This book really set-in-stone my desire to study medicine. Providing much information on the major surge in medical achievement in the post-war years, it provided a perspective to view the practice of medicine today. Not only the achievements themselves, but also how they came about, such as by chance or drug screening. The latter part of the book focused on the possible limitations of medicine in modern society, and that it's future cannot be certain. And that the perpetual advance of medicine, that many believed would continue in the 'age of optimism', has come to barriers more recently. Resulting in a changing subject of both social and intellectual integrity.

Playing Hide and Seek with Tumour Cells

Immunotherapies in cancer treatment attempt to stimulate the body's own immune system to reject and destroy tumours.

Tumours in some people with advanced melanoma have disappeared after treatment with drugs that force the cells out of hiding. With this done, the patient's immune system can act to destroy the tumour, as it can now recognise the cancer.
Tumour cells tend to outfox the immune system as they find ways to camouflage themselves; they grow a ligand- a surface molecule that activates the PD-1 receptor on the T-cell, this fools the immune system to think that tumours are normal tissue.
The drugs used were one of three types of antibodies.T-cells (playing a key role in the immune response, matured in the thymus) should be able to spot these cancer cells as foreign and therefore destroy them. They act by blocking the interaction between the PD-1 receptor and the ligand.; thus allowing the immune system to recognise the tumour as cancer cells.
Another immunotherapy is to genetically engineer a patient's T-cells to recognise and destroy cancer cells. These engineered cells attack any cell with a CD19, which is a unique surface molecule to cancer cells.

Epilepsy's Unpredictability End?

This story now has a personal interest to me- I have recently been suffering from seizures and have now been referred to a neurologist to investigate the possibility of having epilepsy.

A new implant in the brain can warn of seizures minutes before they occur. Without this, epilepsy is incredibly unpredictable- putting people with the condition at risk, it is hazardous and disruptive. The warning of an imminent seizure helps sufferers stay safe.
Seizures can be described like earthquakes: you can't prevent them from happening, but if you predict them you can prepare to mitigate the effects. The implant is a patch of electrodes that measure brainwaves- it learns patterns of activity that indicate a seizure is about to happen. As this happens, the implant signals to a receiver implanted under the collarbone; alerting the person activating a handheld device with warning lights.
This means an enormous change in the independence and confidence of sufferers.

'A revolution in mental health'

Upon reading the NewScientist today, I was drawn to one particular article. This outlined the change of diagnosis procedure of mental health away from a symptom based diagnosis, and toward biomarkers and brain scans. This stood out to me as an issue, not only because I suffer from mental health problems myself, but also because such a huge sector of healthcare has been seemingly left behind research wise. You wouldn't diagnose cancer on the basis of a lump- the tissue would be tested- so why have we been diagnosing mental health issues differently, purely based on on symptoms and not on any objective laboratory measure? This would give rise to more accurate diagnoses, and hence improved help for the patient- that is, if the underlying science is reliable. This shift in technique is desirable, but 'to understand the neuroscience in sufficient depth to build a diagnosis would take time'.

Possible Drug for Autism

Currently, there are no medicines to treat autism's core symptoms.
A meeting in Massachusetts presented the results of the largest clinical trial of a drug for autism. The drug is called arbaclofen- it works by damping down the excessive brain activity. It derives from the already approved drug- baclofen (used to treat spastic muscles); this means that this class of drugs has already undergone safety testing.
150 people with autism either received a placebo or arbaclofen for 12 weeks. Although this drug did not change social withdrawal of the participants, it did make recipients more able to respond appropriate to other people.
Read in more depth: http://www.autismspeaks.org/science/science-news/top-ten-lists/2012/arbaclofen-shows-promise-treating-core-symptoms-autism

Hypothalamus: the Timer of Life

By manipulating the hypothalamus- a small almond shaped part of the brain that controls most of the basic life functions- in mice, researchers have managed to lengthen and shorten the lifespan of mice. This reveals new drug targets that may delay the onset of age-related disease.
 Mice were given gene therapy: one group to inhibit NF-kB- a protein complex that becomes more active in older mice (these lived to 1100 days); one group to activate NF-kB (these lived to 900 days); one group to age naturally (these lived to 600-1000 days). The mice that lived the longest also maintained mentally and physically fit for longer- the mice were given cognitive tests against a control and the longest lived mice performed best.
Post-mortem examinations in the longest living mice (with inhibited NF-kB) showed that they had many chemical and physical qualities of younger mice. Further investigations showed that NF-kB reduces the level of GnRH ( a chemical produced in the hypothalamus) which regulates puberty and fertility. Mice injected with GnRH resulted in new neurones in the brain and they lived longer too, with similar lifespans to that of mice with inhibited NF-kB. When injected directly into the hypothalamus, it influenced other brain regions.