Hello readers! Welcome to the Cambridge Widening Access to Medicine Society monthly newsletter 😊
Food for Thought: an example interview question
You are entering a hospital staff room 15 minutes prior to conducting surgery with your colleague Dr John. When you enter, you see Dr John take a swig of a drink from a bottle and quickly close his locker. You suspect the drink is alcohol. What would you do in this situation?
An ethical scenario! Although you are less likely to get this sort of interview question at an Oxbridge interview, they frequently come up in MMI and traditional panel interviews so being able to apply your foundational ethical knowledge is essential.
Answer:
When looking at an ethical scenario, it is always important to have the four pillars of medical ethics at hand to help structure and inspire your answer. The four pillars are:
Beneficence (doing good)
Non-maleficence (to do no harm)
Autonomy (giving the patient the freedom to choose freely, where they are able)
Justice (ensuring fairness)
In this specific scenario, you are asked to put yourself in the shoes of a doctor and balance your duty to ensure patient safety and your duty of care for your colleague and the work environment. As such, it is vital that you do not make any assumptions or accusatory claims but rather you approach your colleague in an open manner and find out what they were drinking because it very well may be water!
Assuming that you have managed to identify that the drink is in fact alcohol, from a patient safety standpoint, Dr John should definitely not be allowed to carry out the surgery. You should talk to him in a calm manner and encourage him to go home, if this proves difficult then you can involve a superior colleague. However, it is also equally important that you only involve the necessary parties, as you don’t want to spread gossip or rumours around the hospital. Make sure that Dr John does not drive home if he has been consuming alcohol and that he gets home safely.
Now that Dr John is safely on his way home/is being dealt with, you have to either find emergency cover so that the scheduled surgeries can go ahead, or inform the patients and relevant staff that, due to personal circumstances, the scheduled surgeries will not go ahead today.
In the slightly longer term, it is important that you try to work out the underlying cause of the alcohol so that it does not happen again. Of course, this is only if Dr John is comfortable talking to you about it. If he is not, then it is worth suggesting referral to the relevant services that will help del with the problem. Likewise, it is your responsibility to ensure that the incident is accurately reported and is on file so that the relevant procedures can take place.
If you have concerns that a colleague may not be fit to practice, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary.
You have a few options:
a. You can report your concerns to your clinical or medical director
b. You can discuss your concerns with National Clinical Assessment Service (NCAS).
c. report your concerns to the GMC
Returning to the ethical pillars, the most relevant to this case are beneficence and non-maleficence. Of course, you want beneficence for your colleague, and you will help to ensure this by helping him get home safely and exploring any underlying issues later down the line. Likewise, you want to ensure non-maleficence to the patients, and you will do this by ensuring the surgery does not go ahead unless there are qualified and able surgeons to take on the role, by ensuring appropriate cover for the shift is provided and by reporting any concerns you have to the relevant people.
Although this question does at first seem daunting, try to think through it logically by looking at the relevant stakeholders and your duty (in terms of the ethical pillars) towards each of them - hopefully by using a model like this your answer will come naturally and begin to take structure!
Myth-buster - “being a doctor means you have to sacrifice social time and financial security”
As medical school applicants and hopefully future medical students, you will often hear that ‘if you want money, then medicine is not for you’ or ‘if you want to raise a family, you are in the wrong profession.’ Although there is some truth to each of these, they are most definitely far from being accurate!
Tackling the issue of salaries, it is indeed true that the salary of a doctor in the UK is a lot less than that of an equivalent doctor in the US or Australia but, this does not mean that doctors in the UK are not compensated well. Under NHS progression, most FY1 doctors (straight after graduation) can expect to be on a basic salary of between £30,000-35,000 a year, increasing up to the region of £100,000 as a consultant. This, in itself, is a fairly comfortable salary to live on but, in reality, there are many opportunities to take on-call shifts, overtime and even do some private work resulting in a salary up to double the above stated! So, while yes being a doctor in the UK will not give you a salary as high as you might be able to get in finance or banking, it is by no means not enough to help ensure financial security!
Both as a medical student and as a doctor, the reality of the situation is that it will be hard work! Long work days, many exams and a longer degree are part of what it takes to be a part of this rewarding profession. As such, effective time management is key in ensuring that you are able to do all of the social and extracurricular activities that you want to do. You are most definitely able to do all of the things that you want to do if you are able to prioritise well enough at medical school and, when it comes to specialising and progressing through your career as a doctor, there are many options you can take to help ensure shorter working days and more time at home! A common example of this is training as a GP, which tends to have more predictable and structured hours for you to follow. Likewise, if you want even more time for other things there is nothing to stop you from working part-time at your convenience!
Behind the Headlines
Mystery of the environmental triggers for cancer deepens
Cancer biologists like to trace the intellectual basis of their field back to the work of Darwin and Mendel. The former established how natural selection and ‘modification’ (what we would know today as mutation) can cause changes in phenotype over time, while the latter introduced genetics, which is now central to our understanding of these processes. Cancer can be conceptually considered as a result of these processes working at the cellular level. One or more genetic mutations confer an advantage on the cell possessing them, allowing it to divide much faster than neighbouring cells do. Eventually, it displaces neighbouring normal tissues and starts invading other tissues and organs.
Occasionally, some cancers arise almost entirely due to inherited mutations that a patient is born with. In most cases however, at least some of these mutations develop due to interactions between the organism’s genome and environmental factors such as radiation, viruses, toxins, and the like.
The question, then, is which environmental factors are important causative factors for a particular type of cancer? Environmental factors can be linked to particular patterns of genetic mutations (or mutational signatures). So, the answer is to sequence many cancer samples and look for mutations they have in common that can be linked to environmental factors. Of course, when doing this we would want to be sequencing the genomes of cancers which we already think are due to environmental factors.
It thus made sense for the brilliant scientists at the Sanger Institute to try this technique on oesophageal squamous cell carcinoma (OSCC), a type of oesophageal cancer. As the article points out, the incidence of this cancer varies greatly across the world, being particularly high in countries including Kenya, China, Iran, and Turkey. If all these countries were from a single region, we could say that there is probably some hereditary genetic factor at work here. However, these countries are quite distant from each other, so it seems quite likely (theoretically, at least) that there are some common environmental factors underlying their high rates of OSCC.
Unfortunately, this effort turned out to be unsuccessful, and no mutational patterns indicative of any environmental factor were found. For now, there seem to be many possibilities which may explain the outcome of this study. Perhaps the environmental factors are affecting cells at the epigenetic or RNA level, instead of directly causing mutations. Or maybe the high incidence rate in these countries is not due to environmental factors at all. Ultimately, we must remember that a study with negative results is never useless, so long as we ask the right questions afterwards.
The paper itself can be found here:
Link of the fortnight
Gresham College
This college hosts lectures by very qualified and capable lecturers, which are posted online free for anyone to view. They have built up a huge range of lectures over the years, including on topics such as medicine, physiology, vaccinology, and medical law. If you are considering applying for a particular subject in university and want to know how interested you will be in the content, or if you just want to learn more about something you’re interested in, do check them out!
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 month!
Love,
CamWAMS Committee
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