Medicine etc. @medblr-med - Tumblr Blog

mental health in humanitarian crises

some definitions + stats: there were 43 armed conflicts in 2016. Turkey hosts the most refugees, followed by Pakistan and Lebanon. There were 26,000 asylum applications to the UK in 2015 - mainly from Iran, Iraq, Eritrea. 50% of funding from international humanitarian organisations goes to countries hosting refugees. A refugee is someone escaping persecution to go to a country they’re not originally from, with a fear of returning home. A asylum seeker is a refugee who has filed an asylum application, but is still in the process. An IDP is an internally displaced person which means they seek refuge but they are still within the borders of their own country. Europe hosts only 6% of IDPs (so don’t be fooled by the media!).

It’s difficult to ignore stories form the global refugee crisis occurring at the moment. When thinking about how to help people in such desperate situations, we immediately think of the most basic necessities: food, water, shelter, safety..... & mental health wouldn’t really come into it. In fact, less than 0.1% of the funds from international humanitarian organisations go towards mental health services. I’m not making a judgement about this - there are arguably more urgent places that finite funds need to be directed to. Also, for some of these countries there simply is not the infrastructure to support mental health services (I think there are about 8 psychiatrists in the whole of Palestine...).

I do think that we need to readdress attitudes that mental health problems are ‘diseases of privilege’. This is true to some extend. Increasingly accepting societies make speaking out about mental illness something that is admired (not that I’m belittling the stigma that is still very prevalent!), rather than feared and abhorred. In some societies, mental health simply isn’t spoken about. It’s not that people don’t struggle with mental health problems, it’s that they aren’t identified. Also, in emergencies where refuge is necessary, a level of resilience can be built up. This has led to my GP telling me about some of his refugee patients who have no idea why people in our very privileged society can possibly be depressed!

So what sort of mental health issues would refugees be affected by?? I immediately think of PTSD, due to the trauma of conflict (bombs, people being killed). However, this is a very Western concept so it’s quite hard to get reliable stats - apparently PTSD goes up by 50% after armed conflicts.

An interesting TED talk about how to parent you children as refugees - this is interesting and ties in with mental health (specifically of children). https://www.ted.com/talks/aala_el_khani_what_it_s_like_to_be_a_parent_in_a_war_zone

And don’t just think that mental health problems stop when the person is in the new country. Asylum seekers have exceptionally poor mental health, probably related to the fact that they have to go to immigration detention centres with no warning (which arguably have lower standards than prisons!) and answer hours of questions, which could also bring back traumatic memories of torture. They are also not allowed to work, which has it’s own affect on mind and wellbeing.

NGOs work by collecting literature to see if their proposed strategy would actually work. One good example of a potential strategy is E mental health as this could reach more people.

some stats which I can’t source about forensic psychiatry + musings

FORENSIC PSYCHIATRY = assessing mentally unwell offenders, therefore closely tied with the legal system.

15% of male prisoners and 25% of female prisoners have some form of psychosis, compared to a population level of 4%!

It is the job of the psychiatrist to come up with a risk assessment to establish the extend to which the person’s crime could be attributed to a mental illness. This might be difficult if the person fakes a symptom... so sort of impossible to conduct a proper assessment.

This ties in quite nicely with a TED talk my friend recommended to me the other day about how we label ourselves and each other with mental illnesses, and the extend to which this is valid. The speaker cites and example of a man who committed a petty crime and thought he would be better off by faking symptoms to land himself in a psychiatric hospital...... You can watch it here:

https://www.youtube.com/watch?v=xYemnKEKx0c

This also made me think a lot about the functions of prison. There are about 4 which I can think of, told to me in an ethics lesson at school: 1. Punishment (person deserves repercussions to their crime. justice to victim etc). 2. Deterrent (the threat of prison helps stop people committing crimes in the first place). 3. Rehabilitation (possible the most dubious one, as often prisoners reoffend when they are released, but arguably prison can help the person see the ‘error of their ways’ and improve). 4. protection - this one is underlined as I think it underpins the way we think about who is deserving of prison. If someone has a treatable psychiatric illness which made them commit a crime, this not only means that they don’t deserve the punishment aspect of prison, but it also means that they shouldn’t pose a threat to society when they get the correct help, so prison would be unfair and useless. If someone is severely mentally ill, they might not deserve prison, but they still pose a threat to society (e.g. murdering people as told by voices) so need to be ‘contained’ (I cringe using that word when describing human beings). It is obviously unfair to send them to prison, so arguably this is what psychiatric hospitals are for. However based on some accounts, conditions in these hospitals are no better than in prison. Also, we must look at the higher rates of mental illness in prison: is this because of the trauma associated with being in prison, or is it because the psychiatric assessment in the first place was wrong and they should in fact be in a psychiatric hospital??

Anyway, I don’t have the answers to this, but it definitely made me think about the far from perfect justice system/ mental health system that we have!

Celebrating Creativity in Medicine

My new ‘thing’ is seeing elements of the humanities & arts in medicine, rather than just the science. More well rounded people, who are able to appreciate the many aspects that come into patient care, make better doctors :) also I’m getting a bit sick of rote learning medical facts, so it’s nice to feel passionate about medicine, even when it can get a little dry.

I was recommended this website, but haven’t checked it out yet, so am posting it on here for motivation.

To all appearances, Eleanor Longden was just like every other student, heading to college full of promise and without a care in the world. That was until the voices in her head started talking. Initially innocuous, these internal narrators became increasingly antagonistic and dictatorial, turning her life into a living nightmare. Diagnosed with schizophrenia, hospitalized, drugged, Longden was discarded by a system that didn't know how to help her. Longden tells the moving tale of her years-long journey back to mental health, and makes the case that it was through learning to listen to her voices that she was able to survive.

The best lecture I’ve ever been to

This was performed (and I say ‘performed’ for a reason) by a psychiatrist who himself had battled with bipolar disorder for his whole life, and had a very interesting life story and therefore perspective on mental health.

‘Stigma is killing people’. There might be the attitude that it is someone’s fault that they have a mental health problem and people are so much less comfortable discussing it. He quoted a lady who had breast cancer and was inundated with get well soon cards, but when she was hospitalised for severe depression? nothing. Evidence for this is found in a common reason for suicide among people with mental health problem: they have no one to talk to. This is especially a problem in the NHS, where it is not encouraged enough that its own employees take their mental health seriously (e.g. case of female doctor murdering herself and her young doctor when she had a breakdown and couldn’t tell any colleagues). It is a huge problem that medical students and doctors will not engage with mental health services because of STIGMA.

Evidence shows that the BEST way to reduce stigma, more so than education, is contact with people who have the condition. This makes a strong case for people with mental health issues to COP (come out proud!).

Worth noting is that people with severe mental health problems are no more likely to be violent than anyone else (unless drugs and alcohol are involved). This makes me immediately think of countless times when violence is attributed to mental health disorder, or vice versa.

Therefore we NEED very strong attitude if we are to defeat mental health stigma, akin to the attitude of amazing women saying confidently ‘LET’S BEAT BREAST CANCER’ - we need the exact same to defeat the stigma of mental health.

So after explaining stigma and its significance, as well as reciting passages of books, poems, plays on his ‘stage’ to keep the audience engaged and also make a point about creativity (how there has historically been a link between ‘craziness and creativity’ as well as the fact that healing can be helped by the arts), the speaker delved into his own life story.

From being an immigrant from a war-torn country at age 17, to doing his A-levels whislt working 80 hour weeks as a janitor, getting into medical school with top grades (100% in some exams!) and becoming homeless during, to realising his hometown where his whole family still lived had been completely destroyed by bombs..... This all took a toll on him emotionally (’all insanity tkes a little push’) as he experienced bipolar mania and came very close to suicide (his Muslim religion was the only factor that stopped him - it forbids suicide). Thankfully, through medication, prayer, exercise and the arts, he is now able to live a very very happy life, and is not on medication any more. So we have the appreciate the importance of ‘non-medical’ things.

Something he said which was interesting was that often people with bipolar mania wouldn’t want to turn it off because in the hypermaniac ELATED phases, they have so much energy and get so much done. He had a very, very good level of French which he taught himself in 4 weeks whilst manic.

As doctors, it is out responsibility to beware of DIAGNOSTIC OVERSHADOWING. This is when you attribute physical symptoms to those of a mental health problem that the patient happens to also have. This is starkly reflected in the statistics: People suffering from Acute Coronary Syndrome who also have a mental health problem have a 20 YEAR LOWER life expectancy!!!

What I learnt from a talk on child & adolescent mental health

CAMHS accounts for the mental health of those aged <18. This is a shame because as soon as they hit 18, those behavioural/ psychiatric problems tend to be regarded as criminal.

For reference, the definition of a child psychiatric disorder is a quantitative difference in behaviour, feelings or cognition. This might lead to an impairment in development, or suffering. Therefore having something like a temper tantrum is perfectly NORMAL, but if they become so frequent and persistent that they cause significant disruption, the child might be seen by a psychiatrist.

Something that struck me was how common child psychiatric disorders were: 10%. So that means that in an average class at school, there are probably 2-3 children with psychiatric problems. This percentage varies based on a number of things, most notably whether the child lives in an area of deprivation - 10-20% in deprived areas, 5-10% in affluent areas. Other correlates include personal factors (like age, gender, trauma, genetics), family factors (like marital status of parents, arguments at home), and environment. When assessing a child, these factors are listed in a grid to try and see what is contributing to the child’s problems. The original root cause doesn’t matter so much, as it is impossible to identify which is the main problem as factors work together to create a cycle of distress.

Common problems include eating disorders and attachment problems, which are more common than in adults. Whereas schizophrenia and bipolar disorder tend to emerge as we age.

Parents often have the tendency to blame themselves. Parents can definitely do things to change which will help their children, but having more than one child and only one has mental health problems suggests that it is not usually the parents’ fault!

A specific example that the lecturer spoke about was bed wetting. He had a patient who was still wetting the bed at age 9. His parents had been dealing with it very sensibly: not making a fuss when it happened, not telling their child off... but it meant that the boy couldn’t do lots of things normal 9 year olds can do (like go to sleepovers or camps). When questioned more, it came to light that the parents and some other relatives remembered that they too used to wet the bed until an age past the average. This gave them so much comfort, as there is clearly a genetic component to bed wetting and the fact that they themselves are fine means that they knew their child would grow out of it and be fine too. This shows us that often the problem itself doesn’t need to be changed, but the approach sometimes does. So leaving with the same problem that they came in with doesn’t mean it was a failure.

Change is so important, as it is part of the human condition is to think that the same solution will work over and over again (like always making noted before a class....next time!). So it is important that families, schools, environment are looked at to see what can be CHANGED. Sometimes, it is appropriate to advise parents to have marital counselling as often it is familial discourse which is causing the child distress. Suggesting this to the parents in a sensitive way is difficult though. Other solutions include support workers at school, treating a chronic condition like eczema...

There is a slightly strange evidence base for child psychiatric treatments. CBT is said to be very effective, and about 50-70% respond positively to treatment at all. Simple therapies (e.g. with the family) can actually improve physical problems like asthma or diabetes, not by magic, but because it leads to improved understanding and control of the condition thereby modifying behaviour. There are some biological effects also, but these are less significant (e.g. reducing stress reduces cortisol so less glucose is released so better for diabetes).

So in short, CAMHS supports children as early as in utero (!) and is a very multi-disciplinary branch of psychiatry. Making a difference to a child, even if it is small, has a large difference in the future (think like nudging a line off in a different direction will lead to quite a large difference in the endpoints of those two lines).

What I learned from a talk on adults with learning difficulties

I think learning difficulties (LD) bring up a whole bunch of problems ranging from independence, to compliance with medication, to understanding the benefits of physical activity (the mean BMI in the study the lecturer cited was 33!). Therefore creating more accessible information and going through it with the patient is so important. For example, in conveying the need for a diabetic patient with LD to take insulin.

Furthermore, from the study reported (CIPOLD), less than half of the patients with LDs used their phone and few owned a smart phone. This means that apps would have less efficacy than in other groups of people. Also, gaining consent from the participants of the study was harder in the first place, but an absolute right of the patient. However, this along with other factors, means that research is incredibly expensive. Solutions may be very cheap, but without the research to show that they would work, companies may not want to implement them.

LD is not a diagnosis, it is a protected characteristic.

Men die 13 years earlier and women 20 years if they have a learning difficulty! (A reversal of the usual trend as women usually live for longer!). 1.5 million people in the UK with an LD.

simplified versions of healthy eating plans e.g. slimming world

appealing for your case in prison- way more needed accessible version of document!

beware of diagnostic overshadowing!

a yearly health check for people with LD could be a solution.

What I learned from a talk on autism and Asperger’s

So first of all, I’m just going to differentiate between the two ‘conditions’ (they’re not really conditions anyway, as one patient quoted - ‘it’s just who I am’, which is so true. They’re just another way of perceiving the world and there’s an argument that it should not be included in DSM-5 classification as it is not a disease). Asperger’s is basically a form of autism without any speech delay and when the person has a normal or high IQ.

About 1 in 100 people have autism/ aspergers. In the UK, there is a self-referral system as they are so poorly recognised by GPs! the psychiatrist will present the patient with a Questionnaire (developed by Simon Baron Cohen) --> interview for 3-7 hours (with relatives if present) --> reports (e.g. school reports on behaviour) --> multi0disciplinary team meeting --> diagnosis.

This is very complicated for making a single diagnosis, and can take up to 27 weeks! Thankfully, patients don’t tend to mind the long wait as they get seen in the first place pretty quickly (~4 weeks).

Because of the self-referral system, only about 3 in 10 people are diagnosed as having autism. When the other 7 people are told that they do not have autism, this can actually produce quite a bad reaction as that person is left with the uncertainty they came in with, or realise they actually have a personality disorder which carries more stigma.

So what is autism? It’s basically a social variation (that’s how I like to look at it) whereby the person lacks social instinct. Most of us take it for granted that we can pick up and respond to other people’s social queues, but this is actually pretty subtle and hard to explain to someone who lacks this skill. For example, we can tell that someone is bored listening to us if they look a bit distant and fidgety, so we might consider stopping talking. Or, if someone is crying we might give them a hug. Or if someone asks how old they look we might lie and say they look younger than they are. Someone with autism can often not do these things with ease.

Another key feature of autism is that they favour repetition (change is disproportionately stressful, e.g. missing a train, having to take a different route to work. Think about how you would feel if someone made you do something involving a dramatic change where you had no choice, like moving to Russia for 3 years. This might be how an autistic person would feel with something we would view as a minor inconvenience. A semi joke is that autistic people fare better in Scandinavian countries as there is more structure there!) and experience sensation differently (they are hypersensory so might be bothered lots by a quiet sound as they perceive it much louder than other people, as they are overstimulated. Also, they are known to experience pain differently - usually less than other people, or at least they react less. The lecturer cited an example of an autistic person trapping his scrotum in a machine and not reacting at all). So autism is defined as a dyad: 1. lack of social intstinct. 2. repetetive + sensory.

There are tonnes of other features of autism including repeating words, making up words, talking about yourself in 3rd person, using the wrong pronouns, echolalia, echopraxia, sounding like a computer, any IQ, limited speech (does not mean they don’t understand - it is strictly expressive rather than receptive), not understanding jokes or sarcasm.

Due to the variety of presentations of autism, it might present like a thought disorder (if the patient says everything they are doing at that exact moment), schizophrenia (repetition etc). Important to note is that they do NOT lack empathy, they just lack the ability to act on it like others do. So just because an autistic person might not look sad on someone’s behalf, does not mean that they aren’t.

Interestingly, there’s quite a high prevalence of Asperger’s among medical students and doctors. This makes sense as they are often detail-oriented, with a high IQ, good memory, very moral (e.g. ‘snitching’ on people at school). This is a sort of mental paradox. The lecturer described a patient of hers who had about 3 PHDs but found water-cooler conversations at her university the hardest thing of all.

Sadly there’s a similar suicide rather for people with autism and asperger’s as there is with psychosis. If everyone was autistic, there would be no problem (perhaps we should get the label of being ‘neurotypical’!), but it is the feeling of ‘no one understands me’ and ‘why does no one like me’ (as they have no clue how others make non verbal judgements about other people) that leads people to feel totally alienated. Some autistic people end up in jail cells as they are misunderstood when they are having a crisis.

A historical note: Hans Asberger discovered Asperger’s during the second world war but because he was German and published all his research in German, no one over here listened to him! Also, in Chicago, a psychiatrist thought that autism was caused by crappy parenting so ‘treated’ an autistic child by performing a ‘parentectomy’ -- I.e. putting the child into foster care!!!! This was only in the 1960s! Thankfully, in the UK we have the Autism Act which is protective.

Something else interesting is that men tend to present more frequently than women with autism. We don’t know whether this is due to genetics or simply the fact that women historically have to learn to conform more to social norms anyway so are better at hiding it. Also, cultural variations mean that some people would be diagnosed in one country but not in another!! So you could match to that person’s culture.

We unfortunately do not know the cause of autism, but we know that there are 250 syndromes associated with it (including Fragile X, Turner syndrome). I came out of this lecture feeling much more aware with how autism and asperger’s present and how I can be a more wary doctor. For example, the prospect of taking of their clothes for an examination might be worse than actually letting the disease progress in their mind (a patient said this in one of the videos).

what I leaned from a talk by a psychiatrist who was also a psychiatric patient

It is so so important to remember that doctors are people to and, just because they understand the biological basis of disease, does not mean they are not just as prone as everyone else to getting them. This applies to mental illnesses too.

Doctors themselves might often feel that they cannot possibly have a mental health problem, or if they do, they have no time to address it. Furthermore, doctors are especially susceptible to mental health issues due to the high stress and high pressure nature of the job, and risk of emotional-burnout that the job carries. I’m not sure where these stats are from but in the UK, female doctors are twice as likely to commit suicide than the rest of the female population. Of the doctors who do commit suicide, GPs, anaesthetists and psychiatrists have the highest rates.

I think it’s so so important that medical students and doctors support each other and do not reserve mental illness diagnoses strictly for their patients - we are humans too!

What has made me write about this was a lecture I went to given by a prominent psychiatrist who had also struggled with severe depression. Her knowledge of depression did not seem to help at all, and she experienced it just like everyone else. I have thankfully never suffered from depression, but how it was described (in this specific case - obviously everyone is different!) was like having a weight on your chest that might be slightly lifted when talking to someone, or crying, but will always return, and in some cases there is nothing you or anyone can do to lift that weight.

So so many things contribute towards developing depression. Your vulnerability to stress, genes, the biological basis (e.g. low serotonin), early life experiences (e.g. suffering abuse), temperament, physical health (e.g. having a chronic health condition) can all play a role, as I’m sure many other things can too. It is really important to understand that ‘depression’ is an umbrella term. It is not one disease. There are so many different presentations, causes and treatments for it.

The lecturer gave a quotation which I thought was quite good (I can’t remember where she took it from): “In mourning, we grieve the dead. In melancholia, we seem to die with them”. This alludes to the fact that when an adverse experience happens to most of us, we will grieve and be sad, but eventually recover (interestingly she cited failing an exam as something which we would grieve - which I think is true and definitely happens among medical students and perhaps school children - quite worrying really!). However, in depression, you are in a constant state of grieving.

I asked the lecturer a question: Given her extensive experiences with depression (and anxiety and OCD at some points), did she ever let her patients facing similar things know that she had been through it too, to show them that she really did understand what they were going through? So I basically raised the issue of self-disclosure, which is something all doctors should consider. Her answer made a lot of sense: The time you spend as a doctor with your patient is THEIR time - so you cannot make it all about you! Don’t bring up your own experiences, but if the patient asks you if you have been through anything similar, then it is perfectly appropriate to be honest and open with them about it! So basically, tell them but only if they ask!

Something else she mentioned was people’s reluctance to go on any medications citing reasons like ‘that’s not the real me’. Her advise to people who think like that is - what sort of person would you like to be? I.e. Is the person on the pills, no matter the side effects, in a better position than the person without treatment? For her, the answer was yes, but for some people, the side effects might be so bad that this is not the case.

So overall a very interesting talk. For me, there has always been this old-age attitude that doctors should be impermeable to stress, mental illness, physical illness, tiredness...... This is obviously not true and thankfully attitudes are changing! It is in everyone’s best interest to protect the health of their doctors :)

what I learned from a talk on neuroscience & psychiatry

(I should probably take the time to find the papers that this information was sourced from, but I can’t be bothered!)

Recent research has been linking inflammatory changes to various mental health problems. This is rather surprising, as the brain is supposedly an ‘immune privileged area’, facilitated by the blood-brain barrier, as any infection in it is disastrous (encephalitis, meningitis....) so I never really thought about the action of immune cells in the brain. This means that it isn’t really immune-privileged, the immune cells in the brain are just totally different.

Microglia are a type of macrophage (a type of phagocyte) which reside specifically in the brain, having developed from the yolk sac in the embryo. Recently, it has been reported that they are more active in pyschosis (!) and anti-inflammatory medication can have antidepressant effects (!). This was shown as anti-psoriasis medication, to lessen peripheral inflammation, actually worked to improve the person’s mood completely separately, showing that peripheral immune cells, or at least the substances that they release, do have a passage to the brain and can act there.

So what on Earth is the mechanism for all of this? Well, inflammatory cytokines (the chemicals produced by activated macrophages and helper T cells) increase the re-uptake of serotonin (i.e. decrease its concentration in synapses) and also increase IDO which decreases serotonin and neurogenesis. The blood-brain barrier permits the entry of these cytokines (from the periphery) as they increase its permeability and there are specific channels located in the membrane for some of them. We don’t know why...

So this actually sort of makes sense!

There are other immune cells which can act in the brain, with different consequences. Monocytes (a form of macrophages which are only in the blood) act to reduce amyloid protein in the brain, having been recruited by chemokines. Additionally, neutrophils present in the brain have been suggested to lead to a memory deficit.

This is all very exciting. The info here was from my memory of the lecture, so could be far from accurate, but the general gist is that the immune system and the central nervous system are not as apart as we thought they were, and this has vast implications for common mental health problems, such as depression, in terms of focussing on a new angle for treatment in the form of anti-inflammatory medications.

Worth noting is that depression is NOT one single disease, much like cancer. It has so many different causes and contributing factors and so obviously inflammation will only be seen in SOME brains of depressed patients (or psychotic patients), so don’t jump the gun in proclaiming inflammation to be the cause of endogenous depression just yet!

For me, this talk highlighted the cross-talk between neuroscience and psychiatry. Psychiatrists will be better at their job with a firm understanding of neurology, and neurologists will be better at their job with a firm understanding of psychiatry, further supporting ‘neuropsychiatry’ as a field in its own right!

a note on psychiatry

First of all, so many psychiatric conditions/ mental health problems have unexplained causes which lead people to think they are not real as there is no identifiable biological basis. Not only is this false - just because we haven’t found an organic cause doesn’t mean there isn’t one (!) - but it means people say things like ‘it’s all in your head’..... But think.... there’s something pretty important residing in your head, is there not?!

(another thing - psychiatry is the only specialty where there are more female than male consultants!)

What I learned from a talk on ‘transplant psychiatry’

transplant psychiatry

I went to a talk by a liaison psychiatrist (i.e. someone who assess the mental health of patients on a non-psychiatric ward, e.g. a cancer patient) who was discussing the pyschiatric implications of organ transplants, both from the perspective of the donor and the recipient. Having a mental health problem certainly is not a contraindication for being able to give or receive a transplant, but it does make things more complicated (e.g. being compliant with vital immunosuppressants) and might involve the Human Tissue Authority. A study showed that outcomes for psychotic patient 3 years post-transplant were no worse than for other patients, which is encouraging as it suggests that they have the capacity to comply. Furthermore, 93% of donors said they would do it again which is brilliant as it suggests that few regret their decision.

An example of the sort of patient in transplant psychiatry was as woman who received one of her Father’s kidneys and had a nervous breakdown not longer after. This was because her Father had abused her as a child and so receiving his kidneys unleashed a whole load of important and complicated feelings, requiring a psychiatrist’s help. It is worth noting that ALL altruistic donations require a psychiatric assessment to check that they have the capacity to make such a decision, and are not being coerced or bribed. There are other psychiatric implications of donations too. For example, receiving a device to help the heart (not strictly a donation, but I’ll explain anyway) can create a huge amount of anxiety for that patient that the device is going to fail. With the correct patient education about how small this risk is, the patient can be reassured and prevented from experiencing this anxiety.

What I also found interesting, not particularly related to psychiatry, was the debate of opt-in vs opt-out systems for organ donations. Were we (as the UK) to have an opt-out system, there would undoubtedly be way more organs donated. Currently, about 10-15% die while on the transplant list and this could be greatly reduced. However, it is worth noting that proper consent is vital when harvesting someone’s organs posthumously so perhaps a system in between opt-in/opt-out would be appropriate. For example, requiring by law that everyone has to MAKE A CHOICE whether to donate their organs or not. There have been recent developments though in the creation of the pooled donation system, whereby someone can donate an organ to the ‘pool’ if they are not a match for the person who they want to donate to and then that person can receive a stranger’s matched organ in return.

There were a few other facts which I thought were worth noting. Donating one’s organs when live carries a mortality risk. For kidney transplants this is only about 1 in 3000, but for partial liver transplant the risk of death to the donor goes up to 0.5-1%. You can see why people are therefore apprehensive to donate... Also to consider is the time needed off work to recover from such a procedure, which not all of us have the luxury of having.

So the gist of the talk was that mental health and organ donation are intertwined indirectly/ directly: mental health can affect the NEED for a transplant in the first place, it can affect the decision to donate or the outcome of the donor, and it can affect the outcome that the patient has during recovery.

I watched Awakenings in Anatomy class and have been trying to figure out which one of Oliver Sacks' books to get my hands on first,my public library doesn't carry his books so I have to buy them online. Do you have any recommendations? Thanks!

Awakenings is my favourite book but not everyone likes it. It can be quite samey, but the stories are amazing and there's a really nice bit at the end about philosophy and medicine.The Man Who Mistook His Wife For A Hat is really good too, and was the first one I read. It's a lot more diverse in terms of the types of conditions he describes. Musicophilia is also really good. It's all about neurological conditions related to music and how it can be used therapeutically. I've read a few more, but those are my favourites. I'd also recommend his autobiography On The Move, but only after you've read some of his other books as he talks about writing them etc. Hope this helps. X

For the highschool anon asking about chem and physics You should be alright as long as you don't get lower than Bs. Usually teachers are willing to raise your grade depending on how well you do on the AP test so talk to your teachers just in case!!!

Thank you! I think Bs in the UK are a little different to in the US

I only realised a few weeks ago I want to be a physician, and the way school works here I have a long road ahead of me, so I'm following a bunch of med blogs and trying to soak up as much info as possible. Do you have any general advice for me?

Umm well it's difficult to give advice as I don't know which country you're applying from. I applied in the UK so know a lot about that. Basically very vague advice would be to try and spend time actually learning about the job - so shadow doctors in hospitals and volunteer if you can (eg kids with learning difficulties). This will help you get in and also know whether you really want to do it (it's okay to change your mind!). Also read interesting medical books and articles etc to keep yourself 'inspired'! And do your best basically - try not to compare yourself to others.

Hello. Your blog really inspire me. I'm 14 and my big dream is to become a doctor. Anyway, your blog is amazing

Ahh thank you so much! It's great that you're interested so early - just make sure you get as much work experience as you can (when you're a bit older) so that you know it's definitely the right choice for you - Because it's bloody hard work!

•Oliver Sacks•

Trending Blogs

Recently Viewed Blogs

Medicine etc.