Another useful statistic

EDITOR—Davies and Jenkinson’s article in the January issue was excellent,¹ but there is one other thorny problem for the doctor. This is what we might call the “number needed for doctor to be imperilled” (NNDI). This statistic is the number of patients with a given problem that when untreated puts the doctor at risk of feeling that he or she has failed, of being regarded as having failed, or of being sued.

Unfortunately, this number is always 1 because we can treat 99 out of 100 patients with blood pressure of 141/91 mm Hg, but if the 100th dies of a stroke we may be blamed or blame ourselves for this outcome. Hence (at least here in the United States) the excessive practice of defensive medicine, whether in prescribing treatments or testing.

1. Davies P, Jenkinson S. Interpreting the evidence. Student BMJ 2008;16:26-7. (January.) http://student.bmj.com/issues/08/01/education/026.php

Block the brain drain

EDITOR—Perhaps you can blame rich countries for luring much needed medical talent away from poor countries, but you have to consider that with recent mushrooming of private medical and nursing colleges in a country like Nepal, this is bound to happen.¹

Not that this is necessarily a bad thing. More colleges have meant more health staff and more health knowledge for ordinary people. But more private colleges have allowed many people to pursue medicine and nursing, most of them paying for themselves. Most graduates will want some return on the money they have invested in their studies, and often will pursue a career abroad.

Recently the government of Nepal passed an ordinance that all students studying medicine under the scholarship programme must serve at least two years in rural parts of the country after completion of their studies, creating furore. Many students demonstrated and held sit-ins. So much for the selfless doctor. Finally, and perhaps reluctantly, they have agreed to go and work in rural regions. This step is the right one, and I hope that similar ordinances will be passed in other countries.

1. Ahmed W. Doctors and the brain drain. Student BMJ 2008;16:11-2. (January.)

We train ourselves to cope with loss

I wouldn’t want formal training about death

EDITOR—A person’s emotions are the result of influences from early life. We feel the way we feel partly from past experience of the situation and partly from a learning process that results in coping. So it is possible to train someone in what to feel, when to feel, and how to feel, but ultimately different people deal with difficult situations in different ways. From reading Allison Barrett’s article in December’s Student BMJ,¹ it seems she wants guidelines for dealing with loss.

I wouldn’t want formal training about death because if I were taught what I should feel it would kill the natural process of coping, which is something I have gained through experience. We are unique individuals with different experiences; we have our own ways of dealing with any kind of problem, death included. However, I wouldn’t mind some emotional support when I need it.

1. Barrett A. When my patient died. Student BMJ 2007;15:444. (December 2007.) http://student.bmj.com/issues/07/12/life/444.php

Television denigrates donation of cadavers

EDITOR—I find it hard to discuss the shortage of bodies donated for medical research without mentioning Gunther von Hagens, the creator of the plastination technique and notorious for his live, televised autopsies.¹ His Body Worlds exhibition and numerous Channel 4 autopsy programmes show graphic dissections made more gruesome with the help of false blood. The intention is not to educate; they are simply outrageous displays of sensationalism designed to fulfil morbid fascination.

The number of donated bodies has fallen for a number of reasons. But the sooner voyeuristic programmes such as Autopsy: Emergency Room and the like are taken off our screens, the sooner the public will forget about gruesome images of dissected pregnant women and will remember the true reason for donating bodies to medical science—to help the next generation of doctors to learn.

Even if you had previously considered donating your body, you may well rescind when you realise that millions of people may see you being cut in half with a saw from the groin upwards—yes, that was televised. This is certainly not what happens in dissection rooms, but if this is the only exposure the general public get about donated bodies, why should they want to donate theirs?

1. Stott D. Not enough bodies. Student BMJ 2008;16:4. (January.) http://student.bmj.com/issues/08/01/news/004.php

The authors of letters published in this issue of the Student BMJ win a copy of Essential Revision Notes in Surgery for Medical Students.

   

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