The Social Context of Health and Illness (SCHI)

I am going to write about our SCHI course today, a course about the "social context of health and disease"... and about interacting with patients. I've been planning to write about this for a while, but today I am also creating this entry for opportunistic reasons: I need to motivate myself to study SCHI later tonight... the exam is in two weeks!

SCHI is part of the 1st year medical course in Cambridge. It's where students learn about sociology, anthropology and some ethics of medicine. It's where we are reminded that we will deal with patients, which is easily forgotten during the seemingly endless science lectures and practicals. The SCHI course is really well organised and consists of tutorials (ok, supervisions!) and lectures in which we are given factual introductions to the topics, but also meet patients and learn about their experiences in coping with an illness.

Amongst our many science lectures, SCHI offered a welcome break in our schedule where we could remind ourselves of the altruistic reasons for studying medicine in the first place, and realise that science cannot (ok, in some cases, not yet, but certainly not always) explain everything or represent the sole basis for dealing with patients. Obviously, doctors don't deal with the patients' bodies in isolation, but with the entire human being who is real, whose life is embedded into social surroundings, a particular culture, and a society.

I was therefore quite surprised to find out that many medical scholars do not think highly of the course and question its necessity, that the course was apparently imposed onto Cambridge by the GMC (the General Medical Council), and therefore introduced rather reluctantly. (Be aware, this is gossip!)

How interesting. But how can this be?

These opinions of SCHI reminded me of an impression I've had during the first term of medschool, actually starting in the very first week. During that week, the graduates spent time in the hospital and I personally spent an afternoon in the emergency department, where I saw my first open wound and lots of blood. A colleague and I were shadowing a nurse, who seemed to be very good at her job, very experienced, but also somehow roughened up after many years of hard work. We watched her stitch up a young woman with a laceration on her hand. I was surprised by her lack of empathy and harshness towards the poor lady who would not be able to work in her job for a while and would be left with an ugly scar on her hand. Obviously, this was no case of malpractice, but it left a certain impression that kept being reinforced from this point onwards: that the idealism with which one starts medical school must wear off quite quickly.

Back in Cambridge, I then noticed that the loss of idealism is not only discouraged, but sometimes even encouraged (you've just got to imagine that the first patient a standard course medical student meets is a dead one in the dissection room...). Perhaps it is also a result of the huge amount of science taught in the first two years of med school, which somehow makes you lose sight of the more human aspects of medicine.

I guess the subject of sociology does not fit in with this initial desensitisation of the students. Maybe the course brings up topics that doctors don't like to be reminded of, after all it must be very hard to make it through a lifetime of medical practice without gaining some degree of cynicism. Perhaps it also has to do with the fact that a huge part of the first years of medical school is taught and organised by scientists, who can easily relate to the science behind medicine, but maybe not as easily to other "softer" aspects involving care, leaving them dismissive of the subject.

I have decided not to become roughened up yet (hopefully not ever), to keep enjoying the topic and not give up my altruistic intentions too soon.
But it's sad to see that so many undergraduates are drawn in by this atmosphere so dismissive of anything not strictly biomedical. You can truly watch them being molded into shape, so that they will carry on the hubris of the medical profession into the next generation.
Wow, that's getting dramatic now... Now I really have to start studying!!!!

That's it....

Not long ago today, Karl-Theodor zu Guttenberg resigned from his position as Minister of Defense.

In his speech he explained that he made the decision partly because of his doctoral thesis and partly because of his responsibility for the soldiers. He stressed that under the circumstances, he cannot devote full concentration to his duties and attention is being diverted away from the soldiers, who put their lives on the line every day. It should remain obvious though that the core of any of the given reasons for his resignation is his blatant plagiarism. It was yet another statement in which he merely used the word "mistake" with regards to how his thesis was produced, without explaining anything or acknowledging the severity of his actions*. I find this very disappointing.

What also remains is great disappointment with Angela Merkel. She accepted his resignation "with a heavy heart" and somewhat reluctantly. As a doctor of natural sciences, she of all people should have seen that systematic cheating in order to obtain an academic qualification cannot be compatible with a public office. She should have removed him from office in the first place, rather than now appear surprised or even sad about the resignation.

It's shocking how many people seem to think that committing fraud in science is only a serious offense within the world of science. This is very sad given that scientific efforts make an enormous contribution to the advance of our society. These events in Germany therefore tell us scientists that we have to explain much better what we are actually doing, rather than lock ourselves up in the lab every day.


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*Ok, he does say that he will "help to answer" remaining questions regarding his thesis, but that seems bizzarre given that he as the supposed writer should be able to answer any questions on the spot.

More letters to Angela Merkel....

I just heard on the news that 20,000 people (PhDs, PhD students and "normal" individuals ;-)) have signed an open letter to Angela Merkel in which her management regarding the plagiarism of Karl-Theodor zu Guttenberg is strongly criticised. You can find this letter here and here. I just signed it, too!
I was shocked to learn additional detail about how our Minister of Defense's doctoral thesis was generated. I hope that this open letter (rather than the downplaying remarks of the government) will help the public to fully appreciate the severity of the plagiarism committed.

Our minister of defense cheated in his doctoral thesis. What does Dr Merkel think about this?

I wrote a letter to the German Chancellor Angela Merkel today, who used to be a scientist before her political career, and has a PhD in theoretical chemistry. The German Minister of Defense, Karl-Theodor zu Guttenberg, has cheated in his PhD thesis, he copied large passages of other people's scientific writing without citing it (apparently even in the introduction!). Since the beginning of this week, he now no longer carries the doctoral title. Somehow however, his actions are merely seen as a "mistake", and he remains in office. I find this very strange, so I wrote my first ever letter to a famous person. (Actually that's not true, when I was six years old, I once wrote a letter to the Hoff.... ;-))

Sehr geehrte Frau Dr. Merkel,
Ich schreibe Ihnen, weil ich sehr besorgt bin über das Signal, welches durch die Nichtentlassung des Ministers zu Guttenberg an die Öffentlichkeit gesandt wird. Ich selbst habe im Jahr 2008 meine Promotion als Biochemikerin in Oxford abgeschlossen und erlaube mir deshalb die Meinung, die Tragweite der Situation relativ gut einschätzen zu können.
Der heutige Verteidigungsminister hat bei seiner Doktorarbeit von anderen verfasste Textpassagen übernommen und nicht als Zitate gekennzeichnet. Leider sind diese Textstellen so ausgiebig und zahlreich, dass ein einfaches Vergessen der Kennzeichnung oder Übersehen der Passagen als Erklärung keinen Sinn ergibt. Es ist leider nicht nachzuvollziehen, wie eine solch weitreichende Unterlassung ohne das Bewusstsein über eine Täuschung zustande gekommen sein kann. Meiner Meinung nach gibt es dafür nur zwei Erklärungen: entweder war sich Karl-Theodor zu Guttenberg beim Verfassen der Arbeit der versuchten Täuschung bewusst, oder die Arbeit wurde von einer anderen Person verfasst, deren wissenschaftliche Standards leider nicht den Maßstäben entsprechen, die aus guten Gründen an jegliche wissenschaftliche Veröffentlichung angelegt werden. Ich bin sehr enttäuscht, dass dieses Vorgehen des Ministers für ihn selbst, sowie auch für viele Partei- und Regierungsmitglieder ein entschuldbarer menschlicher Fehler zu sein scheint, denn dies ist leider nicht der Fall. Plagiat ist kein Kavaliersdelikt; vor allem, wenn man auch als Vorbild in der Öffentlichkeit steht. Der Doktortitel ist einer der höchsten akademischen Auszeichnungen; wenn es ohne Konsequenzen bleiben soll, diesen durch Betrug zu erlangen, was gilt dann für alle anderen schulischen und universitären Leistungen, die ein Bürger in seinem Leben zu erbringen hat?
Ich kann es leider nur sehr schwer nachvollziehen, wie Sie als promovierte Wissenschaftlerin die Schwere und die Auswirkungen der Fehlhandlungen Ihres Ministers nicht zu erkennen scheinen. Gerade als frühere Wissenschaftlerin müssen Sie die Konsequenzen ziehen, ansonsten ist auch Ihre Glaubwürdigkeit gefährdet. Ich kann sehr gut verstehen, dass es aus machtpolitischen Erwägungen heraus nicht einfach erscheint, einen bislang so beliebten Politiker aus dem Amt zu entlassen. Sie müssen jedoch handeln, ansonsten senden Sie ein Signal, das langfristig sehr negative Folgen für unser Land und das Ansehen der Politik mit sich bringen wird.
Ich hoffe, dass Sie nach gründlicher Überlegung zur selben Schlussfolgerung kommen werden.
Mit freundlichen Grüßen,
Dr. Christiane Riedinger.

... maybe I will get a reply!

five months into med school...

Wow, it's been so long since I last posted something... I had even forgotten that my last entry was about leaving science... now I am already five months into med school!

It's been an intense period of many emotional states, and I thought I'd summarise them briefly. I have to admit, the first few months were hard...
Before I started, I had certain expectations / fears, some of which were met / not met / dealt with, so I can now comment on them retrospectively. Maybe it will help someone considering graduate medicine at a somewhat mature age (possibly even a scientist!) know what to expect… and not to waste any time with these things!

First of all, I was looking forward to learning a lot more about biology and physiology. Being a chemist by training who then became a molecular biophysicist, I had never received an introduction to these topics on a university level. One positive aspect of med school would be to receive this, which would certainly make me a better scientist (If then for any reason med school should not be for me, the outcome would still be somewhat successful).
Starting to study biology and physiology, I realised quickly: There is so much to know – I want to know everything – there is not enough time!
After eleven years in science, I got used to knowing my area of research in great detail. Suddenly I knew next to nothing about things, and it was obviously impossible to get to the same level of expertise on everything in such a short amount of time. I found myself spending a lot of time investigating details, because I was simply not used to covering things on a seemingly superficial level (also why should I have to do that? I really wanted to know!!!). Knowing how much detail there is to everything, I felt faced with an insurmountable amount of knowledge to absorb. The speed with which we were introduced to things did not help either: biochemistry students would learn about a particular topic in a whole year’s lecture series, and we would race through it in less than ten lectures and still be expected to know a lot more than the basics.
I realised that there was a gradient of satisfaction regarding the amount of information absorbed and how much education people had received before: People straight from A-level seemed happiest, but the more people had studied, i.e. undergrad, master's, PhD, post-doc, the more they knew how much there is to know, therefore much they didn’t know, and that caused some degree of dissatisfaction. Given my position in that spectrum, I became pretty frustrated, too!

Another thing I was SOO looking forward to was to be taught again... to sit in a lecture theatre with some kind of expert passing his/her pearls of wisdom onto me. That would be a welcome change to sitting google-ing or pub-med-ing things on my own (which sometimes felt like re-inventing the wheel)!
How wrong I was!!! It is absolutely not the case that someone delivers any information to you on a golden plate… How sad! Even though there are lectures, they are far from ideal. Thank god I know how to google stuff! I was very surprised that there was little attempt made to bring people to the same level at the start of a lecture, how badly structured most lectures were, and how it felt over and over again like someone had just emptied a huge bucket of undigested information over your head! In cases where I already knew the subject being taught, I was surprised how convoluted the topic was presented, how simple things were made to look much more complex than they actually were. Sometimes I knew that crucial pieces of information were missing in order to understand what was being said.
All these problems mean that the students have to spend the great majority of their time picking up the pieces of information and organising them, bringing them into some format that can be understood and then learnt for exams. Again it felt like re-inventing the wheel! With up to 30 hours of coursework every week, there just isn't enough time to do write proper notes on everything… This was another source of great frustration.

Finally, I was worried that I would find it hard to learn things by heart, something that I had not done in years. Also, I knew that most people on my course would be a lot younger than me (I was 30 when I started), and I was worried what this would be like.
This expectation turned out to be true. At the beginning of the course, I felt like I was slower than the other students, in particular the 18 year-olds, who seemed to have a much better memory. Thankfully, this situation changed, and after a lot of studying over Christmas, my mind is now much closer to the way it used to be during my undergrad. What a relief! Even though I am still waiting to reach full capacity again (I hope this is possible!), I am now more confident that I will be able to memorise enough in order to pass the exams. And I have a major advantage: I know what I want to retain for my future career, what I might need, because I have already had the experience of studying and working a job.
Regarding the age difference: I am the 4th oldest out of nearly 300 people! I am even older than most of the graduate medics, who average around 24. I thought telling people my age would not be a problem, but I realised that they do look at me differently because of it. Well, there is nothing I can do about it, so I don't worry any more! ;-)

A few final remarks on something I had not seen coming:
Students in Cambridge are not the most respected of all people. There is this preconceived idea that we are lazy, stupid, and have lots of free time to wait around. Even people who did a medical degree themselves seem to think that. For that reason we are sometimes not dealt with professionally. There are double standards everywhere! Also, there are a lot of fragile egos in charge of students, who would rather put you down than admitting they don’t know the answer to a question. So far, I have not found a way to successfully deal with a person like this and it can be quite demotivating.
Thankfully, many of my graduate peers find this frustrating as well. One of them put this very nicely: we have all had successful careers before, therefore the opportunity cost of us being here is very high. Hence the higher expectations. But the only way is to keep calm and carry on. Always good advice!

However, despite all these frustrations, I am truly enjoying this degree. Everything is so interesting! I have already found that I look at the literature with a much wider perspective, and I am sure this will be useful when I come back to science one day!

what's new?

I haven't posted in ages... it's been a busy year with lots of changes.

I've decided to put my scientific career on ice for a while and start med school. How come?
It's not that I did not like being a post-doc... I loved it: the research, the teaching, learning new things every day (or most days), the flexible working hours and lack of dress code. I love wearing sports clothes to work! What I did not love was being in a constant state of desperation. Desperation for publications, for producing results to put into publications, for experiments to work in order to get results, for a decent project that will let you do experiments that are interesting enough to get them published. See, it's a long chain of desperation, and after a while it is bound to get you down. Additionally, there is a lot of competition out there, and the success is not always distributed fairly. So I decided to take a detour away from science. Maybe (hopefully) I will come back to it one day, but if not, then I will be able to say that my job involves helping people on a really tangible level. If worst comes to worst, it's better to be a failed doctor than a failed scientist!

LOST season 6 is out ;-)

the big day is finally here: the start of LOST SEASON SIX!!!!
while itunes is downloading the first episode, i'd like to say a few words:
it's been a long long wait since the last episode of season five, which was shown on the 13th of may 2009. i cannot believe that it's been this long!!! it was a hard having to worry about sawyer, saiid, juliet, kate, jack, lock and desmond for this long (and claire - where the hell is she???).... today i can look forward to an entire new season to watch, without yet being too sad about the fact that there will be no more lost after may this year.

so today is great day. for the next 86 minutes, i will forget that i have a life and live on an island with icebears, smoke-monsters, scientists and strange indigenous people. yay!