Student BMJ Review: October 2007 issue
Thank you for asking me to review the copy of the Student BMJ. The issue that I looked at was the October 2007 issue, volume 15, pages 337-382. I am a regular reader of both the British Medical Journal and The Lancet but this is the first time that I have read the Student BMJ.
In general, I thought it was extremely well done and provided a most interesting mix of science, education and politics. The main theme of the issue was entitled “Limited Resources” which would imply a major orientation towards the vexed theme of rationing of health resources. The initial editorial mentioned this but also dealt with a number of other issues, including global health and political repression in Burma. The issue itself contains one article on page 343 entitled “Living with rationing” and there are one or two other passing references to this theme in some of the other articles. My gut feeling is that entitling the Journal “Limited Resources” would lead you to believe that a substantial part of the Journal’s content would be devoted to this theme. By way of example, I am currently reading this week’s Lancet, which is devoted to women’s health and maternal health in particular. I estimate that some 80% of the content within the Lancet (volume 370 pages 1283-1392) is devoted to this theme.
I particularly like the short, sharp articles which appear both in the “Newsbites” on page 339 and also “The month in research” which featured on page 379. This struck me as an extremely good way of getting over a large amount of information on a wide range of themes in a way that was lively, topical and capable of maintaining the interest of the reader throughout.
The editorial on “Mesothelioma” on page 341 was for me a little disappointing. This is a devastating form of cancer with a really high mortality and the incidence continues to incease. The figure provided seems to imply that in 1970 the incidence was almost zero and only one other point on the graph was provided at around the year 2000. In the pathology department in which I worked in Newcastle-upon-Tyne in the early 1970s mesothelioma was well recognised and its relationship to asbestos exposure was fully appreciated. I was disappointed by the failure to mention the risk to female close family members following exposure to asbestos carried on the clothes of male workers. It is also, I believe, true that asbestos exposure resulting in mesothelioma can be extremely short-lived and for that reason is often not recognised in the history.
The editorial on rationing on page 343 is obviously topical and relates to one of the most controversial areas in current medical practice. I think this article would really have benefited from some little vignettes from patients who have been affected by rationing. By some strange coincidence, over the previous weekend I met with the wife of an old friend who is having to pay for her lung cancer treatment drug and who complained to me bitterly about the fact that it is freely available in Scotland. Such stories really bring home how cruel and uncaring the impact of rationing of certain types of expensive drugs can be.
I thought the editorial “Mental health in developing countries” was very good and very topical. I think it was a classic example of how a good picture makes a point that a thousand words will not deliver. I was left thinking what the Professor shown on page 345 had studied and taught, and what the impact had been on him and his family. Just as with the rationing editorial, personal impact would have made the message a compelling one.
In relation to the discussion about eponyms on pages 346 and 347, this is a debate which has gone on since I began to study medicine in 1964. For what it is worth, I believe that some eponyms will always remain and I think it is very good that we continue to recognise some of the leading Doctors of bygone years. The follow-on article “Silver syndrome” was very clever in this respect and presumably indicates what the editor of the Student BMJ thinks about eponyms.
I was interested in the article on page 350-351 on respect given to Doctors in India. This is, of course, how medicine used to be in the UK at about the time I qualified in 1969. In the UK the rise of consumerism has changed the way the public think of Doctors and, indeed, as to how medical students think of their medical schools and universities. The real point is that respect has to be earned and whilst the number of complaints within the NHS and the university system continue to rise, it also true that those who have prospered within the system, as either patients or students, continue to hold their Doctors and Teachers in the highest respect.
The article “Communicating with colleagues” is an important one in that the failure of medical colleagues to communicate with other staff members is at the heart of many dysfunctional areas of clinical practice.
Further on in the journal, there was an interesting article on military medicine, the political problems of Burma and a most interesting perspective of a student who had opted out of the City to pursue a career in medicine. This was followed by two interesting personal perspectives from the distinguished Breast Surgeon, Mike Dickson and from the former Secretary of State for Health, Frank Dobson. I like the way the Mike Dickson feature was followed by careers advice on how to become a Breast Surgeon, and I assume also that the earlier article on communication and essential teaching skills on pages 361-362 was also more than coincidental.
I thought the careers advice on applying for your first job was again both helpful and timely and there was a good article on managing postoperative emergencies on pages 365-367. The articles “Community based therapy” and “Community health workers” were obviously related and the “Community health worker” article again focused on global health issues, which of course links back to the “Limited Resources” theme underpinning this particular issue.
Safe prescribing is a current concern of both the General Medical Council and the Chief Medical Officer, and it was pleasing to note, in this context, the articles on prescribing in relation to elderly and children.
In the article “Robotics in urology”, I was impressed by the available technology but left wondering who on earth would take up a Discipline if the future really does mean that a substantial part of the work will be undertaken robotically.
In the picture quiz on page 376, I did wonder if the estimate of malignant transformation of these tumours was on the high side at 1-2%. In the thirty or so years in which I undertook frontline histopathology, I probably looked at one hundred or more of these benign cystic teratomas and I cannot recall a single one that showed any malignant transformation. I don’t doubt that these do rarely occur but a rate as high as 1:50 would seem to be to be a gross overestimate.
The final part of the issue featured a number of short reviews, together with an Eyespy section. As I said earlier, I really like these short punchy type articles as they are easy to read and highly informative.
In conclusion, I really enjoyed reading the Student BMJ. It is always challenging to provide good quality science and education in a lively and topical way and I think the Journal gets the balance about right. The small number of criticisms I have expressed above should be seen in that light. I would encourage all students to read the Journal on a regular basis.
Professor I Lauder, Dean of the Faculty of Medicine and Biological Sciences, Leicester Medical School
