by Laura Ganis
Being tasked with a coursework assignment is probably not the highlight of any student’s day. Having graduated from my psychology degree at University College London, I had my fair share of essay writing experience, so I welcomed the multiple-choice question (MCQ) approach of medical school exams with open arms. The tangibility of ‘the right answer’ in medicine was so enticing; the simplicity of the MCQ answer sheet felt refreshing after three years spent regurgitating the names of authors and dates of experiments that were methodologically limited and invariably contradicted by other research.
So then, as a third year medical student, when I found out that we had to prepare coursework on medical ethics… Goodbye black and white, hello grey. I wracked my brain for an interesting topic to explore, but drew a blank. A few days later I met a young, breathless woman clutching her blue inhaler close to her chest. I asked, “Have you ever been given a brown inhaler to use as well?”
“Nope.” She replied between her gasps.
Nope? Isn’t that the ‘preventer’?
We follow a huge number of guidelines in order to promote evidence-based best practice, and up to that moment, I had had very little incentive to question them. I was a third year medical student, what did I know? Surely if we had a relatively cheap means of preventing the progression of a chronic disease like asthma, we would advocate its use for everyone? Apparently not. Step 1 of the British Thoracic Society (BTS) guidelines for the step-wise management of asthma, advocated by the National Institute for Health and Care Excellence (NICE), was just to use symptomatic relief in mild asthma. For my coursework, I questioned the logic of this; how could we produce a management pathway that escalated with the progressive nature of a disease, and yet the first step did not address prevention?
About a year after I wrote the essay, I was sat in a GP practice for some pharmacy teaching, when someone mentioned that the asthma guidelines had been updated. Low and behold, Step 1 was gone – it was no longer recommended to start patients on symptomatic relief only. I was under no illusion that my essay had absolutely anything to do with the timely update.
This left me questioning what space there is for a medical student to challenge decision-making giants like NICE or BTS. Indeed, within the medical profession there is a tendency towards a hierarchical culture that impedes debate amongst the profession as a whole, regardless of the topic. The conceptualisation and scrutiny of medical ethics is not necessarily grounded in clinical experience or knowledge though, so shouldn’t junior healthcare professionals and students have a role to play in questioning the codes by which we practice?
Laura Ganis is a final year medical student at Barts and the London currently undertaking a Medical Innovation, Entrepreneurship and Medical Technology internship at Vopulus – a medical education tech startup in Shoreditch.