It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia.
Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritize the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications.
We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. "Just Google it..." is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape.
The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, lay people, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter patients)expect from an encyclopedia. Since the prestige of direct authorship if off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanity’s lot' is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant side-effects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and banishing rebellious editors. A study featured in the First Monday journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors.
Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury.
March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice.
Illustrator Edward Wong
This blog post is a reproduction of an article published in the Medical Student Newspaper, November 2013 issue.
Funny and Creative Mind Maps & Mnemonics that really help you better understand the magic and abstract medical world. Specially for USMLE Step1 students... Don't forget to buy your First Aid Step 1 Book, watch the videos with your Fantabolous MindMaps printed. Enjoy this blog!
The registrar's face was taking on a testy look. So enduring was the silence our furtive glances had developed a nystagmic quality. “Galactosaemia” came her peremptory reply. Right on queue the disjointed chorus of ahs and head nods did little to hide our mental whiteboard of differentials being wiped clean. At the time conjugated bilirubinaemia in children only meant one thing: biliary atresia. A fair assumption; we were sitting in one of three specialist centres in the country equipped to treat these patients. Ironically the condition has become the unwieldy yardstick I now measure the incidence of paediatric disease.
Biliary atresia is the most common surgical cause of neonatal jaundice with a reported incidence of 1 in 14-16ooo live births in the West. It is described as a progressive inflammatory obliteration of the extrahapatic bile duct. And Dr Charles West, the founder of Great Ormond Street Hospital, offers an eloquent description of the presenting triad of prolonged jaundice, pale acholic stools and dark yellow urine:
‘Case 18...It was born at full term, though small, apparently healthy. At 3 days however, it began to get yellow and at the end of 3 weeks was very yellow. Her motions at no time after the second day appeared natural on examination, but were white, like cream, and her urine was very high coloured.’
1855 was the year of Dr West's hospital note. An almost universally fatal diagnosis and it would remain so for the next 100 years. The time's primordial classification of biliary atresia afforded children with the 'noncorrectable' type, a complete absence of patent extrahepatic bile duct, an unfortunate label; they were beyond saving. Having discovered the extent of disease at laparatomy, the surgeons would normally close the wound. The venerable Harvardian surgeon, Robert E. Gross saved an enigmatic observation: “In most instances death followed a downhill course…”
K-A-S-A-I read the ward’s board. It was scrawled under half the children's names. I dismissed it as just another devilishly hard acronym to forget. The thought of an eponymous procedure had escaped me and in biliary atresia circles, it's the name everyone should know: Dr Morio Kasai.
Originating from Aomori prefecture, Honshu, Japan, Dr Kasai graduated from the National Tohoku University School of Medicine in 1947. His ascension was rapid, having joined the 2nd department of Surgery as a general surgeon, he would assume the role of Assistant Professor in 1953. The department, under the tenure of Professor Shigetsugu Katsura, shared a healthy interest in research.
1955 was the landmark year. Katsura and Kasai operated on their first case: a 72 day old infant. Due to bleeding at the incised porta hepatis, Katsura is said to have 'placed' the duodenum over the site in order to staunch the flow. She made a spectacular postoperative recovery, the jaundice had faded and there was bile pigment in her stool. During the second case, Katsura elected to join the unopened duodenum to the porta hepatis. Sadly the patient's jaundice did not recover, but the post-mortem conducted by Kasai confirmed the development of a spontaneous internal biliary fistula connecting the internal hepatic ducts to the duodenum. Histological inspection of removed extrahepatic duct showed the existence of microscopic biliary channels, hundreds of microns in diameter. Kasai made a pivotal assertion: the transection of the fibrous cord of the obliterated duct must contain these channels before anastomosis with the jejunal limb Roux-en-Y loop. This would ensure communication between the porta hepatis and the intrahepatic biliary system. The operation, entitled hepatic portoenterostomy, was first performed as a planned procedure for the third case at Tohoku. Bile flow was restored and Kasai published the details of the new technique in the Japanese journal Shujutsu in 1959. However, news of this development did not dawn on the West until 1968 in the Journal of Pediatric Surgery. The success of the operation and its refined iterations were eventually recognized and adopted in the 1970s. The operation was and is not without its dangers. Cholangitis, portal hypertension, malnutrition and hepatopulmonary syndrome are the cardinal complications. While diagnosing and operating early (<8 weeks) are essential to the outcome, antibiotic prophylaxis and nutritional support are invaluable prognostic factors.
Post operatively, the early clearance of jaundice (within 3 months) and absence of liver cirrhosis on biopsy, are promising signs. At UK centres the survival after a successful procedure is 80%. The concurrent development of liver transplantation boosts this percentage to 90%. Among children, biliary atresia is the commonest indication for transplantation; by five years post-Kasai, 45% will have undergone the procedure.
On the 6th December 2008, Dr Kasai passed away. He was 86 years old and had been battling the complications of a stroke he suffered in 1999. His contemporaries and disciples paint a humble and colourful character. A keen skier and mountaineer, Dr Kasai lead the Tohoku University mountain-climbing team to the top of the Nyainquntanglha Mountains, the highest peaks of the Tibetan highlands. It was the first successful expedition of its kind in the world. He carried through this pioneering spirit into his professional life. Paediatric surgery was not a recognized specialty in Japan. By founding and chairing multiple associations including the Japanese Society of Pediatric Surgeons, Dr Kasai gave his specialty and biliary atresia, the attention it deserved.
Despite numerous accolades of international acclaim for his contributions to paediatric surgery, Dr Kasai insisted his department refer to his operation as the hepatic portoenterostomy; the rest of the world paid its originator the respect of calling it the ‘Kasia’. Upon completion of their training, he would give each of his surgeons a hand-written form of the word ‘Soshin’ [simple mind], as he believed a modest surgeon was a good one.
At 5 foot 2, Kasai cut a more diminutive figure one might expect for an Emeritus Professor and Hospital Director of a university hospital. During the course of his lifetime he had developed the procedure and lived to see its fruition. The Kasia remains the gold standard treatment for biliary atresia; it has been the shinning light for what Willis J. Potts called the darkest chapter in paediatric surgery. It earned Dr Kasai an affectionate but apt name among his peers, the small giant.
Miyano T. Morio Kasai, MD, 1922–2008. Pediatr Surg Int. 2009;25(4):307–308.
Garcia A V, Cowles RA, Kato T, Hardy MA. Morio Kasai: a remarkable impact beyond the Kasai procedure. J Pediatr Surg. 2012;47(5):1023–1027.
Mowat AP. Biliary atresia into the 21st century: A historical perspective. Hepatology. 1996;23(6):1693–1695.
Ohi R. A history of the Kasai operation: Hepatic portoenterostomy for biliary atresia. World J Surg. 1988;12(6):871–874.
Ohi R. Morio Kasai, MD 1922-2008. J Pediatr Surg. 2009;44(3):481–482.
Lewis N, Millar A. Biliary atresia. Surg. 2007;25(7):291–294.
This blog post is a reproduction of an article published in the Medical Student Newspaper, April 2014 issue.
There are roughly 7000 medical students graduating each year from 33 medical schools in the UK. Medical degrees take either 4, 5 or 6 years depending on the route you take.
The government via the Student Finance Company will pay for your tuition fees for the first 4 years of any undergraduate degree. After this the NHS will pay for the last year or 2 years of the undergraduate medical tuition fees.
The maintenance loan depends on family income. The figures aren’t easy to find for the background of most UK medical students but a ‘guestimate’ based on my medical school is that 50% went to a private school, 30% went to selective state schools and 20% went to a comprehensive. Of the private school kids probably about half had a scholarship or bursary. So, a rough guess would be that 70% of med students come from a “middle class” family who have a decent income but not huge wealth and are therefore eligible for a ‘maintenance loan’ above the minimum. This majority therefore rely on there loan to get through the year.
An average student income is between £1000 and £1500/term (£1200 average-ish). Most university terms are 10 weeks, hence average income is about £120/week. As a preclinical medical student this is fine and we are on par with everyone else. As soon as we become clinical med students the game changes!
Clinical years are far longer, more like 40 weeks a year rather than 30. Students are on placement, have to dress professionally and travel to placement daily. This adds additional costs and requires the money to stretch further. Doubly bad!
Once, the NHS starts paying the tuition fees, the Student Loans Company starts reducing the maintenance loan, by half! Why?
A final year student or a 4th year who has intercalated now has to survive at University for one of their course’s longest years with half the money they had previously. >40 weeks on a loan of roughly £1500/year. This situation is pretty much unique to medical students.
Some students are lucky enough to have parents who can afford the extra couple of thousand pounds required for the year. Some students get selected into the military and get a salary. A greater proportion find part time jobs to help cover the cost and the rest have to resort to saving money where they can and taking out loans.
When I was a member of the BMA medical student committee I did a project as part of the finance sub-committee investigating the loans available for medical students. Many banks used to “professional development loans” which allowed medical and law students to borrow money for a year before they had to start repaying the loan. Hardly any banks now offer this service, so the only loan available is an overdraft or a standard loan that requires you to have a regular income.
This means that final year medical students with limited family support may have to live for a year on less than £2000. Does this seem fair? Does this seem sensible government policy?
Medical students are 99% guaranteed to be earning over £25 thousand pounds within a year. We will be able to repay any loans. So why isn’t the Student Loan Company allowing us to continue having a ‘normal’ maintenance loan? And why aren’t banks giving us the benefit of the doubt and helping us out in our time of need?
When I was on the BMA MSC there was talk of having a campaign to lobby government and the banks to rectify this situation but I can’t say I’ve been aware of any such campaign. Are the NUS, BMA, UKMSA or anyone else doing anything about this?
Please do leave a comment if you do know if there has been a progress and if there hasn’t why don’t we start making a fuss about this!
I was approached by Meducation to become a resident blogger, and was initially surprised by the invitation as - I must explain upfront - I am not a clinician of any type! I'm one of those project managers. So when considering where to begin to write my first blog post I decided to focus on the use of technology in medical education.
Then when I began writing my first post I was reminded of the complexities of such a topic! And I realised that this is not something that can be covered in one post.
So this is where I thought I would start:
Technology is changing our lives at an ever increasing rate, and it is influencing the way we do a range of tasks from the use of technology in the hospital to the use of technology in education, notwithstanding all other aspects of our lives and the way we communicate. We are educating children in schools at the moment who will have careers and jobs that don't even exist at the moment, the rate of change is exponential. But with this consistent churn of information, communication and technological developments, how do you keep up? Where do you start? As a teacher, as a learner.
I wanted to concentrate this post on considering some of the challenges which can be encountered when working in medical education. One of the pivotal issues is probably resistance. Resistance has a negative connotation and I use it cautiously. Resistance can be in many forms and can arise for a number of reasons.
Technology brings about change, and inherently change can make people nervous. And with change you often encounter resistance; resistance to change, resistance to adapt, resistance to engage - the fear of the unknown. With an ever evolving world, where technology is infiltrating the way we live, work and learn, it is natural that this will influence the way we deliver education, including medical education.
Technology is so fast moving it can considerable time to become familiar with new mediums of developing educational resources, by which time often new iterations and new technologies have arrived.
However, for those providing subject matter expertise for educational resources it is essential that they under the medium through this will be delivered. And for learners, which we all are, it is important to understand how you learn and how technology can help you do this.
With the changes to the NHS and developments in education technology do people find some comfort in being able to both deliver and receive education in a traditional manner?
This poses a unique and very interesting challenge to answer for those involved in medical education, in trying to meet the demands of those seeking information and education in new and interesting ways with those who enjoy traditional classroom based education - all from both the point of view of the 'teacher' and the 'learner'.
How to we satisfy the appetite of those seeking cutting edge education with the demand for traditional classroom learning? Is it possible to meet the needs of all?
The use of smartphones amongst health care professionals is now estimated to be in excess of 85%, with Apple's iPhone currently being the most popular platform. There is a wealth of information (from popular blogs, to formal journals) that demonstrate the potential of smartphone apps (and technology in general) to improve healthcare. However, despite widespread use of smartphones, proper application of the software at our disposal has been arguably poor. The latest mobile Apple operating system 'iOS 8', may be the start of a long-awaited overhaul of the current health apps available.
The App Store - as it stands
The Apple app store boasts many hundreds of what it describes as 'medical' apps. A review of the 'Top 200' medical apps conducted in 2012 by this author revealed that 49% were in fact general health or lifestyle applications aimed at the general public. The same process was repeated this year (2014) and demonstrated that this percentage has increased to 54%. This increase in apps aimed at the general public suggests that Apple do not differentiate between 'medical apps' and 'health and lifestyle' apps. This could negatively affect health care professionals' perception of the otherwise high-quality medical apps that are available. In addition, of the remaining percentage of apps aimed at healthcare professionals, only 5.56% were deemed to be of clinical benefit (an increased from 3% in 2012). The overwhelming majority of 'medical' apps aimed at medical professionals are actually educational in content and usually focus on the learning of anatomy.
Current health apps
Much like the 'medical' apps, only a limited selection of the health apps that are aimed at the public/patient are deemed to be high-quality. Prominent examples include the blood glucose monitors that record data in to a smartphone and similarly, the blood pressure and pain diaries. These examples focus on people with medical conditions, but it is important to note the potential of apps in preventative medicine too (i.e. promoting general health). Typical high-quality apps in this category include RunKeeper and Map My Ride. These apps allow everyone to become their own personal trainer and keep an accurate record of their physical activity. Smartphones will even send reminders to the user that a workout is due, and the option is present to share your stats and 'compete' with friends/family via social media. These features highlight the absolute vanguard of what could potentially come in terms of technology influencing healthy living.
A current criticism of health apps is that most (if not all) are individual enterprises with very little information shared between them. The metaphor of 'silos' is used to represent these large vessels of information that sit adjacent to one another whilst never benefiting from the contents of one another. The iOS 8 operating system hopes to ameliorate this current issue with its new Health app and HealthKit, which will enable developers and their apps to pull data from several health related apps into one streamlined app. It is envisaged that this app will be able to feed (with the appropriate permissions of course) health related information to your family physician for health monitoring purposes. This could have impressive effects in community blood pressure management and blood glucose management (just to name the obvious ones).
There are scattered anecdotal reports of users being wary of centralised health information and as always Data Protection is a major concern (whether it is warranted or not).
In addition, whilst a large percentage of the population may have a smartphone many may still opt not to use health related apps. Poor uptake will obviously limit the perception of this medium as a method of health monitoring.
Smartphone usage is high and many healthcare related apps are already available either to serve as medical tools to healthcare professionals or health monitoring devices for the public. Currently, Apple does not seem to differentiate between medical and lifestyle apps on its app store and many lower quality apps seem to appear in 'medical' searches. Also, Current apps do not share information. However, with iOS 8 it seems that Apple seems to be addressing several key issues surrounding the use of the iPhone as a health monitoring device. For the moment it seems that healthcare professionals will have to harness this patient-held approach. Perhaps direct improvements to the medical aspect of the Apple app store and the quality and originality of apps aimed at doctors is still a little way off.
Previously on Meducation..
The 'F***-it‘ Button’: an account of the (red) button that when activated triggers (in the initiator and possibly a nearby friend) a ‘mental state of no-return’; a mindset during which there is no form of resistance to indulging in whatever foodstuff is wanted, when wanted, (temporarily) guilt-free. Read my previous post here.
In Search of the 'F***-it Button' Cure
I do not know whether since writing the previous entry, with increased awareness of this ‘state of mind’, I have become a ‘F-it button’ hypochondriac, but I am sure that I have been increasingly experiencing ‘F*** button’ symptoms.
This did not bother me at first: Boston Tea Party’s flapjack selection is the perfect essay incentive and, it is March therefore baggy jumpers are still legit…
In other words, my increased ‘F***-it’ button tendencies did not seem worth addressing.
However, my illness behaviour, like any other, influenced by economical (Boston Tea Party flapjacks are quite expensive), environmental (Baggy jumpers have limited capacity) and cultural factors (Lent), culminated in ‘help-seeking’ behaviour.
Lent is a six and a half week period during which Christians, (and others who want to practice self-discipline), give up a luxury to remember the forty days and forty nights Jesus spent alone in the desert without food, being tempted by the Devil. With this in mind, my initial thoughts on Pancake Day was, ‘why not try give up the F***-it button..!?’.
Feeling rather full and overindulged at the time – pathognomonic post-‘F***-it button’ symptoms – I sought to find my cure and decided to self-medicate… Baggini’s book.
As I was on holiday, my first challenge was the ‘all-you-can-eat’ (‘eat-what-you-like’/’eat-as-much-as-you-like’) breakfast buffet. I always find that my ‘hunter-gatherer’ streak comes out in this kind of situation: stock up on as many K-Cals as possible in order to cope with the possibility of later starvation. This primitive approach, in combination with my indecisive nature, invariably results in assembling everything and anything from the buffet bar onto my plate and the ‘F***-it button’ is inevitably activated... At which point I order the full English breakfast.
On the morning of Ash Wednesday I was determined to avoid this and, in anticipation of the ‘breakfast-buffet-F***-it button-trigger’, I consulted my book.
One reason that Baginni cites for why we fail to stick to resolutions is that, whilst we may have a clear objective, we haven’t thought about it enough. That is to say, we may think that we have clearly decided not to do something, for example, ‘hit the ‘F-it button’’. However, we haven’t actually fully taken into account that we also have the belief that, of any given ‘buffet-bar-situation’, that it wouldn’t be ‘so bad’ if we indulged after all because,(for example), ‘we may be hungry later’. Thus, faced with temptation, the ‘F-it button’ is activated regardless of initial good intention.
A solution to this problem is a form of ‘metacognition’, to draw what is known as a ‘bright line’, a clearly defined rule or standard. The ‘bright line’ should be achievable and not too restrictive. In my case, I made the rule, ‘no more than one portion of cereal and a pastry of choice at the buffet bar’.
However, despite my ‘bright line’, the first day of Lent was a little bit of a fail…
The problem with a ‘bright line’ is that if you don’t actually believe that the 'bright line' matters, when faced with temptation it will probably be crossed and… let’s just say, I put the extra eggs benedict, other pastry, creamy hot chocolate and couple of yoghurts down to this limitation.
It seems that a ‘bright line’ only works if you believe in respecting it and, for the rest of the holiday I gave that ‘bright line’ all the respect it deserved. Lent was going really quite well.
But then I got back to Bristol, to essay writing and to Boston Tea Party. I reached for Baggini’s book…
‘There isn’t a very strong relationship between capacity to engage in dietary restriction – to consciously restrict intake – and [low] BMI [because] in effect you’re expending so much energy making one kind of mental effort that you don’t leave yourself enough for others. This suggests that although metacognition can be useful in impulse control for one-off temptations, relying on it as a medium- or long-term strategy may not work.’
I have horrible feeling forty days counts as ‘medium’ to ‘long term’.
The NHS provides care free at the point of us to British citizens and anyone who needs emergency care while in the UK. It tries to provide every kind of service and treatment that it can but obviously there are limits.
The NHS gets its money mainly from governments taxes, charities, research grants, some payment for services and from renting out retail space etc. Healthcare is a financial blackhole, any money put in the budget will get spent, efficiently and effectively or not.
The NHS is constantly being expected to provide a better, more efficient service and new treatments, without a comparable increase in government funding. So, why doesn’t the NHS set up services that could make it money?
Some money making suggestions
Gift shops and NHS clothing brand – The American hospital I went to for elective had quite a large shop near the entrance that sold hospital branded goods. People love the NHS and it could make itself a brand, “I love the NHS” t-shirts, “I was born here” ties, “I gave birth at Blah hospital” car stickers, hats, jackets, tracksuits, teddy bears in white coats and so many more things could be sold in this shops to raise money for the NHS.
Patients in a hospital are a captive market and their visitors are semi-captive. The captives get very bored! Why not provide opportunities for these people to spend their money and relieve the boredom while they are in hospital with some retail therapy? For instance, new hospitals should be built with a shopping mall in them and a cinema. A couple of clothes shops would give people something to do and raise money from rent.
While we are on the subject of new hospitals, they should be designed with the input of the clinical staff who know how to maximise the flow of patients through the "patient pathway". Hospitals should be built like industrial conveyor belts: patients enter through ED, get stabilised, get fixed in theatre, stabilised again in ITU, recover on the wards and out the exit to social services and the outpatient clinics.
New hospitals should be designed to sit on top of HUGE underground multi-story car parks. If shopping centres can do this then so can hospitals. Almost all hospitals are short of parking spaces and most car parks are eye sores. So, try to plan from the beginning to get as many car parking spaces as possible. Estimate how many are needed for staff and visitors - then double it! Also, design a park and ride system so additional parking is available off site.
If costa can make money from a coffee shop in an NHS hospital, why isn’t the NHS setting up its own brand of high quality coffee shops in the hospitals and cutting out Costa the middle man?
“NHS healthy eating” – NHS branded diet plans or ready meals could be produced in partnership with a supermarket brand. Mixing public heath, profit and the NHS brand. “Good for you and good for the NHS”
The NHS could set up hospitals abroad that are for profit institutions that use the NHS structures, or market our services to foreigners that they then pay for. Health tourism is a thing, why not make the most of it?
“NHS plus” – the NHS should be a two tier system. Hours of 8am til 6pm should be for elective procedures free at the point of use and free emergency care. Between 6pm and 11pm the hospitals currently only do emergency care, so there is loads of rooms and kit lying about unused. Why not allow hospitals to set up systems where patients can pay for an evening slot in the MRI scanner and cut the queue? Allow surgeons to pay to use the facilities for private procedures in the evenings. Allow physicians to pay to use the outpatients clinics for private work after hours.
An “NHS Journal” could publish research and audits conducted within and relevant to the NHS.
“NHS pharma” – the NHS buys a huge amount of off patent drugs, why not produce them itself? Set up a drug company that produces off patent medication, these can be given to the NHS at cost price and sold to other healthcare providers for profit. NHS pharma could also work with British universities and researchers to produce new drugs for the British market that would be cheaper than new Drug company drugs because they wouldn’t need huge advertising budgets.
There are so many ways the NHS could make more money for itself that could then be used to deliver newer and better treatments. Yes, it is a shift in ideology and culture, but I am sure it would have positive outcomes for the NHS and patients.
If you have any ideas on how the NHS could produce more money then please do leave a comment.
Last Wednesday (27/11/13) was Birmingham Medical Leadership Society’s second lecture in its autumn series on why healthcare professionals should become involved in management and leadership.
Firstly, a really big thank you to Mr Smart for travelling all the way to Birmingham for free (!) to speak to us. It was a brilliant event and certainly sparked some debate. A second big thank you to Michelle and Angie – the University of Birmingham Alumni and marketing team who helped organise this event and recorded it – a video will hopefully be available online soon.
Mr Tim Smart is the CEO of King’s NHS Foundation Trust and has been for the last few years – a period in which King’s has had some of the most successive hospital statistics in the UK. Is there a secret to managing such a successful hospital?
“It’s a people business. Patients are what we are here for and we must never forget that”
Mr Smart doesn’t enjoy giving lectures, so instead he had an “intimate chat” covering his personal philosophy of why we as medical students and junior doctors should consider a career in management at some point.
Good managers should be people persons. Doctors are selected for being good at talking to and listening to people – these are directly translatable skills.
Good managers should be team leaders. Medicine is becoming more and more a team occupation, we are all trained to work, think and act as a team and especially doctors are expected to know how to lead this team. Again, a directly transferable skill.
Good managers need to know how to make decisions based on incomplete knowledge and basic statistics. Doctors make life-altering clinical decisions every day based statistics and incomplete knowledge. A very important directly transferable skill.
Good managers get out of their offices, meet the staff and walk around their empires. Doctors, whether surgeons, GP’s or radiologists have to walk around the hospitals on their routine business and have to deal with a huge variety of staff from every level. To be a great doctor you need to know how to get the best out of the staff around you, to get the tasks done that your patients’ need. Directly transferable skills.
Good managers are quick on the up-take and are always looking for new ways to improve their departments. Doctors have to stay on top of the literature and are committed to a life-time of learning new and complex topics. Directly transferable.
Good managers are honest and put in place systems that try to prevent bad situations occurring again. Good doctors are honest and own up when they make a mistake, they then try to ensure that that mistake isn’t made again. Directly Transferable.
Even good managers sometimes have difficulties getting doctors to do what they want – because the managers are not doctors. Doctors that become managers still have the professional reputation of a doctor. A very transferable asset that can be used to encourage their colleagues to do what should be done.
A good manager values their staff – especially the nurses. A good doctor knows just how important the nurses, ODP, physio’s and other healthcare professionals and hospital staff are. This is one of the best reasons why doctors should get involved with management. We understand the front line. We know the troops. We know the problems. We are more than capable of thinking of some of the solutions!
“Project management isn’t magic”
“Everything done within a hospital should be to benefit patients – therefore everything in the hospital should be answerable to patients, including the hospital shop!”
“Reward excellence, otherwise you get mediocrity”
At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite.
Email us at firstname.lastname@example.org
Follow us on Twitter @UoBMedLeaders
Find us on Facebook @ https://www.facebook.com/groups/676838225676202/
Come along to our up coming events…
Thursday 5th December LT3 Medical School, 6pm
‘Why should doctors get involved in management’
By Dr Mark Newbold, CEO of BHH NHS Trust
Wednesday 22nd January 2014 LT3 Medical School, 6pm
‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’
By Prof Jon Glasby, Director of the Health Services Management Centre , UoB
Thursday 20th February LT3 Medical School, 6pm
‘Creating a Major Trauma Unit at the UHB Trust’
By Sir Prof Keith Porter, Professor of Traumatology, UHB
Saturday 8th March LT3 Medical School, 1pm
‘Applying the Theory of Constraints to Healthcare
By Mr A Dinham and J Nieboer ,QFI Consulting
After I retired from my academic position at the University of Miami, I started working as an intermittent ob & gyn in various cultural settings in the US and abroad. In 2006 I practiced in a hospital in New Zealand.
I saw many interesting cases during my six months at Whangarei Hospital. One stands out in particular. This was a middle aged native Mauri woman who had been seeing her family doctor for several years because she was gaining too much weight, her abdomen was getting bigger, and she was constipated. Each time the family doctor saw her, he did not examine her but patted her on the back and encouraged her to eat less, eat more fruit and vegetables and be more active so that she would lose weight. When much later he finally examined her, he noticed a large tumor in her abdomen and referred her to the hospital.
To make a long story short, we operated on her and removed a large ovarian cyst weighing more than 18 kilograms (about 40 pounds). This cyst fortunately turned out to be benign and the woman did well. The operation itself was something else as we needed an extra assistant to hold the tumor in her arms while we removed it without breaking it.
Even though this large tumor was certainly not a record, we ended up publishing the case in a New Zealaned medical journal for family practice (see reference below), not so much for the nature of the tumor itself as for pointing out to family doctors (all doctors, in fact) that examining patients before giving them advice is most important.
Alison Gale, Tommy Cobb, Robert Norelli, William LeMaire. Increasing Abdominal Girth. The Importance of Clinical Examination. New Zealand Family Physician. 2006; 33 (4): 250-252
The book of the week this week has been Chris Patten’s “Not quite the diplomat” – part autobiography, half recent history and a third political philosophy text. It is a fascinating insight into the international community of the last 3 decades. The book has really challenged some of my political beliefs – which I thought were pretty unshakeable – and one above all others, the EU. I read this book to help me decide who I should vote for in the upcoming MEP elections.
I have to make a confession, my political views are on the right of the centre and I have always been quite a strong “Eurosceptic”. Although recently, I have found myself drifting further and further into the camp of “we must pull out of Europe at all costs” but Mr Patten’s arguments and insights have definitely made me question this stance.
With the European Parliamentary elections coming up, I thought it might be an interesting time to put some ideas out there for discussion.
From a young age, I have always been of the opinion that Great Britain is a world leading country, a still great power, one of the best countries in the world - democratic, tolerant, fair, sensible - and that we don’t need anyone else’s “help” or interference in how our country is run. I believe that British voters should have a democratic input on the rules that govern them.
To borrow an American phrase “No taxation without representation!”
I believe that democracy is not perfect but that it is the best system of government that humans have been able to develop. For all of its faults, voters normally swing back to the centre ground eventually and any silly policies can be undone. This system has inherently more checks and balances than any meritocracy, oligarchy or bureaucracy (taking it literally to mean being ruled by unelected officials).
This is one of my major objections to how the European Union currently works. For all intents and purposes, it is not democratic. Institutions of the EU include the European Commission, the Council of the European Union, the European Council, the Court of Justice of the European Union, the European Central Bank, the Court of Auditors, and the European Parliament. Only one of these institutions is elected by the European demos (the parliament) and that institution doesn’t really make any changes to any policies – “the rubber stamp brigade”. The European Council is made up of the President of the European Council (Unelected), President of the European commission (Unelected) and the heads of the member states (elected) and is where quite a lot of the "major" policies come from but not all of the read tape (the European Commission and Parliament).
I am happy to be proved wrong but it just seems that the EU, as a whole, is made up of unelected officials who increasing try to make rules that apply to all 28 member states without any consent from the voters in those states – it looks like the rule of “b-euro-crats” (bureaucrats – this version has far too many vowels for a dyslexic person to use).
A beurocratic rule which many of us do not agree with but seemingly have to succumb to, a good example for medics is the European Working Time Directive (EWTD) which means that junior doctors only get paid for working 48h a week when they may spend many, many more hours in work. The EWTD has also made training a lot more difficult for many junior doctors and has many implications for how the health service is now run. Is it right that this law was imposed on us without our consent? If we imposed a treatment on a patient without their consent then we would be in very big trouble indeed!
I cannot deny that the EU has done some good in the world and I cannot deny that Britain has benefited from being a member. I just wish that we could pay to have access to the markets, while retaining control over the laws in our lands. I want us to be in Europe, as a partner but not as a vassal. In short, I would like us to stay within the EU but with major reforms.
I know that any reforms I suggest will not be read by anyone in power and I know they are probably unrealistic but I thought I would put it out there just to see what people think.
I would like to see a NICE’er European Union.
The National Institute for Clinical Excellence is a Non Departmental Public Body (NDPB), part of the UK Department of Health but a separate organisation (http://www.nice.org.uk/aboutnice/whoweare/who_we_are.jsp). NICE’s role is to advise the UK health service and social services. It does this by assessing the available evidence for treatments/ therapies/ policies etc and then by producing guidelines outlining the evidence and the suggested best course of action.
None of these guidelines are enforced by law, for example, as a doctor you do not have to follow the NICE recommendations but if you ignore them and your patient suffers as a consequence then you are likely to be in big trouble with the General Medical Council.
So, here would be my recommendations for EU reform:
First, we all pay pretty much the same as we do now for access to the European market. We continue with free movement and we keep the European Council but elect the President. This way all the member states can meet up and decide if they want to share any major policies. We all benefit from free movement and we all benefit from a larger free trade area.
Second, we get rid of most of the rest of the EU institutions and replace them with an institute a bit like NICE. The European Institute for Policy Excellence (EIPE) would be (hopefully) quite a small department that looks at the best available evidence and then produces guidance on the policy.
A shorter executive summary would hopefully also be available for everyday people to read and understand what the policy is about - just like how patients can read NICE executive summaries to understand their condition better.
Then any member state could choose to adopt the policy if their parliaments think it worthwhile. This voluntary opt-in system would mean that states retain control of their laws, would probably adopt the policies voluntarily (eventually) and that the European citizens might actually grow to like the EU laws if they can be shown to be evidence based, in the public’s best interests, in the control of the public and not just a law/red tape imposed from above.
The European Union should be a place where our elected officials go to debate and agree policies in the best interests of their electorates. There should therefore be an opt-out of any policy for any member state that does not think it will benefit from a policy.
This looser union that I would like to see will probably not happen and I do worry that one day we will wake up in the undemocratic united federal states of Europe but this worry should not force us to make an irrational choice now. We should not be voting to "leave the EU at all costs" but we should be voting for reform and a better more co-operative international community.
I would not dare suggest who any of you should vote for but I hope you use your vote for change and reform and not more of the same.
Medical blogging is blogging in the field of medicine. It is a relatively recent addition to the medical field. While its closest predecessor medical journalism; is about 300 years old, medical blogging is currently about a decade old. This blogpost aims at exploring the field of medical blogging and comparing it to related disciplines when relevant. It examines some opinions of bloggers, and reviews some medical blogs aiming to infer reasons for blogging, derive technique or outline of blog and hopefully arriving at a conclusion to the future prospects of medical blogging.
Medicine is the practice of the art and science of healing 'ars medicina'. It is a branch of applied science, which started probably in the pre-historic era. The practice continued to flourish, specialise, sub-specialise and sub-sub-specialise.
The word blog is most probably derived from the contraction of the words 'web log' which is a form of website that is more interactive, allowing comments, tagging,and is displayed in counter-chronological order from the most recent at the top of the page. The term 'blog' is currently used as a noun as well as a verb. The aggregation of blogs is named 'blogosphere', and the blog writer is named 'blogger'. There are single author blogs and multi-author blogs, they are as diverse in there content as the diversity of the bloggers, with regards to form they can be written text, images, videos, sounds or combination of more than one medium. The term 'blogroll' is referred to blogs followed by a person. Blogging is just more than a decade old now. However, the number of blogs have been increasing exponentially at times. The concept of blogging is considered as one of the components of the concept of web 2.0.
Medical blogs refer to blogs that are primarily concerned with medical/health subjects. The name 'medical blog' is derived from content based taxonomic classification.
Medical blogs can be classified by author, there are blogs by physicians, nurses, patients, medical institutions, medical journals, and anonymous blogs. They can be classified by target audience as either to other doctors, patients and carers, general public or a combination of more than one target. There are also medical blogs by patients or patient blogs that expresses their viewpoints. A study examined medical student blogs and concluded that they might be beneficial for students to reflect on their experience (Pinilla et al, 2013). The Nephrology Dialysis and Transplantation (NDT)
made it own blog (El Nahas, 2012). The American Journal of Kidney Disorder (AJKD) made its own official blog (Desai et al, 2013). During the same year, the American Heart Association and American Stroke Association launched their official blog (Sanossian & Merino, 2013). Pereira discussed the blogs by neurosurgeons (Pereira et al, 2012).
In the BMJ doc2doc blogs, they do not have to meet certain number of word count but will have to be reviewed prior to publication. KevinMD requires blog posts to be of maximum five hundred words, Medical-Reference require a minimum of one thousand words. Meducation requires a blog post to vary between 1500-3000 word. Independent blogs may show more variation in the number of words per blog post. Some blogs are predominantly in text format, other may combine multimedia or get linked to other medical blogs.
The BMJ doc2doc tentatively recommends blog posting to be in the frequency of one to two blogs/month. Chrislyn Pepper, a medical blog writer, (2013) states that medical blogging can aim to be 'three blogs of 300+ words each week and three to four short blogs of less than a hundred words five days per week.'
Medical bloggers seem to have various reasons to blog, some communicate clinical data to fellow doctors, in this case some blogs seem to resemble research or review articles in content and language which can contain medical jargon. There are diagnosis blogs that were studied by Miller and Pole (2010). The comparison between the electronic predecessors of blogging including Electronic Bulletin Board, USENET, and emailing in addition to the why of blogging in general has been discussed by Mongkolwat
(Mongkolwat et al, 2005). Some put their hypotheses forward, others share clinical experience or discuss a clinical matter. Some bloggers direct their attention to the general public providing information about medical topics. Some discuss issues which can be difficult to be put in research topics. Dr Rob discussed that importance of medical blogging as an equivalent to the concept of democracy in an online world. Doctor Blogger website offers 10 reasons for medical blogging including public education, correction of misconceptions and establishing a name. For the medical blogger's direct benefit Medical Rant blog offers an overview of personal benefits from medical blogging including stimulation of thought and stimulation of academic writing. Dr Wible seems to use her medical blog to promote a standard of care that seems to be a mix between the medical model and the befriending model of care. Another study examined the young adults blogging and concluded that powerlessness, loneliness, alienation, and lack of connection with others, where the primary outcomes of young adults as a result of mental health concerns (Eysenbach et al, 2012). Wolinsky (2011) enquires whether scientists should stick to popularizing science or more.
Medical blogs are essentially online activity which renders them immediately accessible to any area with internet connection, they are paperless by definition which makes them more environment friendly. The medical blogs are open access by default which adds to the accessibility, and they are decentralised which decreases control over the control and seems to accentuate diversity.
As compared to peer reviewed journals, medical blogs seem to be less referenced, are hardly ever taken as academic writing, the process of peer reviewed medical blogs is minimal if any, and they do not get reflected on resume or be considered as publication, though the term 'blogfolio' started to become a watch word. It seems hard to base clinical decisions on medical blogs. However, medical blogs can offer more diversity into research and non-research medical topics. They are published online with no delay or review time, they can comment on the most recent advances in the medical field or most contemporary issues instantaneously. Very recently, citing blogs seems to become a bit accepted. BMJ Journals have their dedicated blogs
Some online resources give a comprehensive outline on blogging in general and medical blogging in particular including video interview with a medical blogger
Michelle Guilemard in her blog makes a valid point of how medical blogging can enhance career. Medical Squid also highlighted medical blogging as a career
Kovic et al (2008) conducted a research on the medical blogosphere an concluded that 'Medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers'. Miller & Pole (2010) concluded that 'Blogs are an integral part of this next stage in the development '. Stanwell-Smith (2013) discussed the aspect as an important tool to communicate with patients. The blur between academia and blogging was discussed in research blogs. (Sheema et al, 2012). During the same another study discussed the impact of blogging on research (Fausto et al, 2012).
While Baerlocher & Detsky (2008) warn in an article against the hazards of medical blogging due to potential breach of confidentiality. After an exhaustive study of the content of weblog written by health professional, Lagu reached the concern of breaching of confidentiality (Lagu et al, 2007). Rebecca Golden (2007) cites the perils of medical blogging she concludes her article saying 'Science has a peer-review process for a reason'. Brendan Koerner (2007) in wired magazines posted an article about the problems of giving medical advice via blogging. Dr Val Jones makes a point by concluding that social media provide the 'allure of influence'. Thomas Robey (2008) offers arguments for and against medical blogging, including confidentiality, and ruining personal reputation on the negative side, while enhancing democratization of conversation and having a creative outlet on the positive side. Brendel offers an intriguing discussion to whether it would be ethical or not to monitor patients' blog to determine their health status. (Brendel, 2012).
O'Reilly voiced in 2007 the need for blogging code of conduct. The GMC published guidance on the use of social media by doctors and it included blogging as a form of social media. The Royal College of General Practitioners also published the social media high way code to offer guidance on social media including medical blogging. There is also the medblog oath online.
Flaherty (2013) argues that blogging is under attack by micro-blogging, and that it is in its deathbed. Mike Myatt in his article Is Blogging Dead, discusses various views about blogging in an era of micro-blogging The Royal College of Psychiatrists recently introduced a number of blogs including the president's blog, overseas blogs and other blogs. The medical blogging seems to occupy a middle space between the quick micro-blogging and the thoughtful research article. Its diversity and freedom are its strongest tools and can have the potential to be its worst enemies. One wonders whether the emergence of guidelines for medical blogging – given the seriousness of the content – would save medical blogging and elevate it to the next level or change the essence of it. After all, the question is how much the medical field which is a top-down hierarchy accept grass-root movement. Freedom of expression is probably at the heart of blogging. It would be logistically impossible to impose rules on it. However, guidelines and code of honour may help delineating the quality of medical blogs from each other.
This post is previously posted on doc2doc blogs.
Bibliography & Blogiography
Brendel, D. Monitoring Blogs: A New Dilemma for Psychiatrists Journal of Ethics, American Medical Association, 2012, Vol. 14(6), pp. 441-444
Desai, T., S.M.A.N.V.S.K.T.J.K.C.K.B.E.J.K.D. The State of the Blog: The First Year of eAJKD Am J Kidney Dis., 2013, Vol. 61(1), pp. 1-2
El Nahas, M. An NDT blog Nephrol Dial Transplant (2012) 27: 3377–3378, 2012, Vol. 27, pp. 3377-3378
Eysenbach, G., B.K.M.M. What Are Young Adults Saying About Mental Health? An Analysis of
Internet Blogs Journal of Medical Internet Research, 2012, Vol. 14(1)
Fausto, S. Machado, F.B.L.I.A.N.T.M.D. Research Blogging: Indexing and Registering the Change in Science 2.0 PLoS one, 2012, Vol. 7(12), pp. 1-10
Lagu, T, K.E.J.D.A.A.A.K. Content of Weblogs Written by Health Professionals J Gen Intern Med, 2008, Vol. 23(10), pp. 1642–6
Miller, EA., P.A. Diagnosis Blog: Checking Up on Health Blogs in the Blogosphere American Journal of Public Health, 2010, Vol. 8, pp. 1514-1518
Mongkolwat, P. Kogan, A.K.J.C.D. Blogging Your PACS Journal of Digital Imaging, 2005, Vol. 18(4), pp. 326-332
Pereira, JLB., K.P. d.A.L. d.C.G. d.S.A. Blogs for neurosurgeons Surgical Neurology International, 2012, Vol. 3:62
Pinilla, S. Weckbach, L.A.S.B.H.N.D.S.K.T.S. Blogging Medical Students: A Qualitative Analysis
So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly).
And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from?
Science believes it may have discovered the answer- mirror neurons.
In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'.
It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons.
Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return.
Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.)
Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way?
Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared.
However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place.
Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing.
So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!