Hello readers! Welcome to the Cambridge Widening Access to Medicine Society fortnightly newsletter 😊
Happy Halloween!
Food for Thought: an example interview question
What issues should be considered in deciding whether to not continue a patient’s life-sustaining treatment?
Behind the Headlines
The role of doctors in working alongside their patients to encourage a healthy diet is increasingly important as the prevalence of lifestyle-related cardiovascular and metabolic disease has continued to rise. Often considered separately, there has been growing recognition of the role doctors have to play in advocating for urgent action to limit accelerating climate breakdown, due to the implications this crisis has for human health. This article in The Guardian highlights how these two issues are closely aligned, exemplifying how health promotion efforts can have broader effects on the environmental impact of our lifestyles, and hence the health outcomes of a greater number of people than simply the patients we are advising.
The article can be found below:
Healthy diet means a healthy planet, study shows, The Guardian Mon 28 Oct 2019: https://www.theguardian.com/environment/2019/oct/28/healthy-diet-means-a-healthy-planet-study-shows
The article focuses on a study published by a group from The University of Oxford in the journal PNAS. They found that foods associated with improved health (whole grain cereals, fruits, vegetables, legumes, nuts, olive oil, and fish) have markedly lower environmental impacts than foods associated with negative health outcomes such as red meats and processed meats. Importantly they discuss how consumers, policy makers, and food companies need to better understand the alignment between the health and environmental implications of food choices.
It may be that in the future information on the environmental impact of food is displayed on food packaging in a similar way to information on the nutritional contents. In order to reach this point of empowering consumers to make positive choices, more information on these impacts needs to be gathered and research into whether this intervention would lead to behaviour change must be carried out.
Link of the fortnight
If you want to find out more about the implications of climate breakdown on human health & how healthcare professionals can respond then this link is incredibly useful: http://www.lancetcountdown.org/
The key message of the Lancet Countdown Report is that there is still time for effective intervention and that we can seize opportunities for public health presented by the climate crisis.
The ‘Multimedia’ section in the ‘Resources’ area has a short video which is a good introduction to the Lancet Countdown (Link here: https://youtu.be/moYzcYNX1iM). This is a key issue that will affect the practice of doctors in the future and touches on principles of public health and medical ethics that are important to be familiar with for medical school interviews & medical practice!
Myth-buster
Medical school is all work and no play.
NOT TRUE! Medical students still have plenty of time to have fun and pursue their interests. Many of you will be living with friends for the first time, and all universities have a huge range of student run societies covering everything you could possibly imagine (and more besides!) Of course time management is important, especially close to exams - but this is something you’ll already have experience with from school and college, and will quickly become expert at!
Food for Thought: An example approach
The GMC recognises that some of the most challenging decisions in end of life care are about withdrawing (or not starting) treatment that has the potential to prolong a patient’s life. This may include things like antibiotics for life-threatening infection, cardiopulmonary resuscitation (CPR), renal dialysis, artificial nutrition and mechanical ventilation.
This is a difficult question, and interviewers will just be looking for a discussion of some of the factors involved in deciding what is the patient’s best interests. As always, the 4 basic principles of medical ethics are a good starting point.
Autonomy: Asking the patient what they want is crucial. If an adult patient refuses treatment the law says this must be respected, even if the treatment is the only thing keeping them alive. If they request to continue the treatment the law says you do not necessarily have to agree, but it makes sense to respect their wishes unless you have a very good reason. This is providing the patient has capacity i.e. they can understand, retain and weigh-up the relevant information, and then communicate their decision. If a patient lacks capacity, and has no documentation such as an ‘advanced decision’ refusing treatment, then the doctor decides whether continuing treatment is in the patient’s best interests. However you have a duty to speak to someone who knows the patient, and take into account the patient’s past wishes, feelings, beliefs and values.
Beneficence: You need a good understanding of the person’s clinical situation and the proposed treatment to know if it will likely be of benefit in managing symptoms, improving the clinical condition or prolonging life. Social, emotional and welfare considerations must also be taken into account.
Non-maleficence: Is there treatment burdensome, or likely to increase or prolong suffering? Importantly, you are considering the harms of a specific treatment; you cannot argue that continuing to live is not in the best interests of the patient.
Justice: You could bring up issues of resource allocation- for example ICU beds for mechanically ventilated patients are expensive and in high demand. Of course justice also means giving these patients the same quality of care as others, and not stopping treatment that is in their best interests just because they are approaching the end of life.
It is important to show you understand that these are complex decisions that would be made by a team of experienced doctors and other healthcare professionals - not something you would be deciding in isolation. You could also mention some recent cases in the news that highlight these principles e.g. that of Charlie Gard (N.B the laws on consent and capacity are a bit different in children).
Thanks for reading – if you have any questions then as ever please just email us at access@clinsoc.co.uk!
Hope you have a great fortnight and GOOD LUCK!
Love,
CamWAMS Committee
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