The role of a Medical Lab Technician is critical

Cleaning and care of general laboratory Glassware and equipment. Diagnostics plays prominent role in the field of Medicine. Proper diagnosis of the disease plays an important role in concluding the patient’s condition without which medical treatment/ surgery can not be obtained. The role of a Medical Lab Technician is critical for proper diagnosis and interpretation of results. Clinical studies in the fields of Medicine, Pharamacutical Industries, and Nutrition etc. also require the technicians.

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1.1. Introduction to Medical Lab Technology
Medical Laboratory Technology also called Clinical laboratory science is an allied health profession which is concerned with the diagnosis, treatment and prevention of disease through the use of clinical laboratory tests. It is a combination of the techniques along with the application of theoretical knowledge to perform complex procedures on tissue specimens, blood samples and other body fluids. They look for bacteria, parasites, and other microorganisms; analyze the chemical content of fluids; match blood for transfusions; and test for drug levels in the blood that show how a patient is responding to treatment. The tests which are performed provide critical information enabling physicians to diagnose, treat and monitor a patient’s condition.
A Medical Laboratory Technologist (MLT) do these tests by analyzing body fluids, tissues, blood typing, microorganism screening, chemical analyses, cell counts of human body etc.
The process carried out by a technician is
Collection of the patient’s information
Sampling
Testing of samples
Reporting and documentation of the results
They determine the presence, extent or absence of disease and provide data needed to evaluate the effectiveness of treatment.
The various application of medical lab technology include,
Laboratory Technicians is required in various departments in medical and Pharmacy colleges
In diagnostic centers
In hospitals of various sectors
Quality control R&D sectors of Drug Manufacturing units
Clinical studies in various laboratories
National Institute of Nutrition
Central Drug Research Laboratory
Molecular Biology Labs
With increasing automation and the use of computer technology, the work of technologists and technicians has become less hands-on and more analytical. The complexity of tests performed, the level of judgment needed, and the amount of responsibility workers assume depend largely on the amount of education and experience they have. Clinical laboratory technologists usually do more complex tasks than clinical laboratory technicians do.
There are two levels of medical laboratory workers
Technologists
Technicians
Technologists:
Medical technologists have more training and job responsibilities. They perform complex tests such as microscopic examinations of tissues, blood and other body fluids to detect evidence of disease and detect the presence of bacteria, fungi, parasites etc and chemical tests to determine blood cholesterol levels. They also match blood samples for transfusions and test drug levels in blood to determine how patients are responding to medications. They are often responsible for making sure that testing is done accurately. In some labs, technologists conduct research under the supervision of medical researchers.
Medical technologists work in five major areas of the laboratory
Blood banking
Clinical Chemistry (chemical analysis of body fluids)
Hematology (blood related)
Immunology (study of immune system)
Microbiology (study of bacteria and other disease organisms)
Clinical chemistry technologists:
They prepare specimens and analyze the chemical and hormonal contents of body fluids.
Microbiology technologists:
They examine and identify bacteria and other microorganisms.
Blood bank technologists:
Also referred as immunohematology technologists, collect, type, and prepare blood and its components for transfusions. Immunology technologists examine elements of the human immune system and its response to foreign bodies.
Cytotechnologists:
They prepare slides of body cells and examine these cells microscopically for abnormalities that may signal the beginning of a cancerous growth.
Molecular biology technologists:
They perform complex protein and nucleic acid testing on cell samples.
Technicians:
Medical technicians do routine laboratory testing manually according to instructions. They work under Technologists or supervisors. Technicians may prepare specimens and operate machines that automatically analyze samples. In addition to running tests, technicians set up, clean, and maintain laboratory equipment, such as centrifuges, microscopes etc. They also prepare standard solutions for use in the lab. This involves measuring and mixing the correct amount of various chemicals.
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1.2. ROLE OF MEDICAL LABORATORY TECHNOLOGIST:
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A Clinical Laboratory Scientist’s role is to provide accurate laboratory results in a timely manner. Safeguards, such as experimental controls, calibration of laboratory instruments, delta checks and periodic surveys should be carried out.
Medical laboratory technologists work in a dynamic and evolving environment, and use technological equipment to provide information that must be processed rapidly and accurately.
The major role of clinical lab technologists is:
They perform a full range of laboratory tests – from simple prenatal blood tests, to more complex tests to uncover diseases such as HIV/AIDS, diabetes, and cancer.
They are responsible for confirming the accuracy of test results, and reporting laboratory findings to pathologists and other physicians.
The information result given by the lab technologist influences the medical treatment a patient will receive.
They operate complex electronic equipment, computers, and precision instruments costing millions of dollars.
They assist doctors and nurses in choosing the correct lab tests and ensure proper collection methods.
They receive the patient specimens, analyze the specimens, interpret and report results. A pathologist may confirm a diagnostic result, but often the medical lab technologist is responsible for interpreting and communicating critical patient results to the physician.
They should recognize anomalies in their test results and know how to correct problems with the instrumentation.
They take preventive measures to minimize errors and reject contaminated or sub-standard specimens.
Role of Medical Laboratory Technologist:
The medical technician has the job of carrying out the more basic tasks and his responsibilities include:
Ensuring that the laboratory and the equipments and glassware used in laboratory remains clean.
Proper placement of chemical, equipments and glassware.
Ensuring that there are proper labels pasted on the bottles of chemicals and reagents.
The equipment used in the lab is in proper shape and handled carefully and proper safety measures are observed when handling specimens.
All specimens and other material in the lab are disposed off in a safe and appropriate manner.
A complete record of tests carried out in the laboratory is maintained.
Fresh material is indented through a medical officer and the material is stored in a proper and safe fashion.
Common tests performed in a clinical lab are:
Complete blood count (CBC)
Comprehensive metabolic panel (CMP)
Liver function tests (LFT)
Renal function tests (RFT)
Thyroid function test (TFT)
Urine analysis
Hematological analysis
Lipid profile
Semen analysis (for fertility and post-vasectomy studies)
Serological studies
Routine cultures.
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1.3. ETHICS:
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The medical lab technologists are bound by the ethical codes. Laboratories shall not engage in practices restricted by law and should uphold the reputation of their profession.
The medical lab technologists are required to adhere to the following code of ethics
The general idea of healthcare ethics is the welfare of the patient. The laboratory should treat all patients fairly and without discrimination.
The main aim of laboratory ethics is collecting the proper information of the patient, which enables the requested examinations and other laboratory procedures to be carried out
Safety of staff and other patients are legitimate concerns when communicable diseases are possible and information may be collected for these purposes.
All the information is collected with the knowledge of the patient and the patients should be informed regarding the procedure carried out.
Forcing some one to undergo medical testing of any kind is an invasion of privacy and a violation of human rights.
Special procedures, including the more invasive procedures, will require a more detailed explanation and, in some cases, written consent.
The result of the test should be kept strictly confidential and to be reveled only with the concern of the patient.
The laboratory should endeavor to see that results with serious implications are not communicated directly to the patient without the opportunity for adequate counseling.
Procedures that are carried out should be published in established/authoritative textbooks, peer-reviewed texts or journals or in international, national or regional guidelines. Any manipulation of result is completely unacceptable.
The results should be reported to the doctor and may be reported to other parties with the patient’s consent or as required by law.
The laboratory results should be correctly interpreted and applied in the patient’s best interest.
All records should be legible and stored such that they are readily retrievable. Records may be stored on any appropriate medium subject to national, regional or local legal requirements.
As per National Accreditation Board for Testing and Calibration Laboratories (NABL) guidelines, the minimum period for retention of test reports issued shall be five years for histopathology and cytopathology and one year for other disciplines.
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1.4. Responsibilities of medical lab technologist
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Medical laboratory technologists perform examinations with a microscope, perform complex tests, analyze the results, and report them to the medical professional for diagnostic use. Medical Laboratory Technologists operate a variety of complicated instruments. They must have good motor skills, hand-eye coordination and manual dexterity. In addition to technical skills, they must have a strong attention to detail in order to detect subtle change to the microscopic appearance of blood, tissue and bacterial cells. MLTs must also determine the validity of the results they obtain, which requires analytical and critical thinking. MLTs work in an ever-evolving environment, and on occasion need to design new procedures to reflect the rapid pace of change in their workplace. Whether working alone or as a member of a team, the MLT must be able to manage time efficiently and communicate clearly. Responsibilities of medical lab technologists usually include:
Conducting advanced chemical, bacteriological, immunologic, biological and hematological tests
Examining specimens with microscopes
Making cultures of tissues and body fluids to reveal parasites, bacteria, fungi and other microorganisms
Analyzing chemical content, chemical reactions and blood concentrations of certain compounds
Typing and cross-matching samples of blood for transfusions
Evaluating results of tests
Establishing and modifying programs and procedures to ensure quality control and test accuracy
Supervision of medical lab technicians (also known as clinical lab technicians).
The medical technician has the job of carrying out the more basic tasks and his responsibilities include –
Ensuring that the laboratory and the equipments and glassware used in laboratory remains clean.
Proper placement of chemical, equipments and glassware.
Ensuring that there are proper labels pasted on the bottles of chemicals and reagents.
The equipment used in the lab is in proper shape and handled carefully and proper safety measures are observed when handling specimens.
All specimens and other material in the lab are disposed off in a safe and appropriate manner.
A complete record of tests carried out in the laboratory is maintained.
Fresh material is indented through a medical officer and the material is stored in a proper and safe fashion.
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1.5. Safety Measures and First Aid
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Safety is not just a concept but it is a habit which must be developed by every person associated with the medical laboratory field. One should remain attentive and cautious during the time he or she is inside the laboratory as a small mistake can lead to a grave situation. The personnel working in the medical laboratory must be aware of the how to handle the chemicals, glassware, specimen and equipments etc. as mishandling or improper handling may lead to serious injury or contamination and is dangerous to life.
Certain basic safety steps that must be followed in the laboratory are
Keep the workplace clean and organized.
Label all storage areas, refrigerators, etc., appropriately, and keep all chemicals in properly labeled containers.
Date all bottles when received and when opened.
Note expiration dates on chemicals.
Note special storage conditions.
Be aware of how to handle and store hazardous materials such as –
Flammables
Radioactive Compounds
Corrosives
Biohazards
Toxics
Carcinogens
Reactive
Compressed Gases
Follow the safety instructions for handling chemicals and segregate chemicals by compatibility groups for storage.
Be aware of the potential interactions of lab furniture and equipment with chemicals used or stored in the lab. (e.g., are oxidizers stored directly on wooden shelving?)
Post warning signs for unusual hazards such as flammable materials, biohazards or other special problems.
Use equipment only for its designated purpose.
Position and secure apparatus properly to avoid any damage to personnel or equipment.
Use protective clothing all the time (e.g. lab coat, face mask, gloves etc.)
Do not smoke, eat or drink in the laboratory.
Ensure proper disposal of waste generated from the laboratory.
Clinical lab technologists generally deal with infectious samples. Therefore proper methods of infection control and sterilization are followed, few hazards exist. Protective masks, gloves, and goggles often are necessary to ensure the safety of laboratory personnel.
First Aid in Laboratory Accidents:
Accidents in the lab may result from either chemicals including acids or alkalis coming in contact with any body part or toxic substances or from heat of flames, hot liquids, explosions etc. Broken glass or contamination from infected material or specimen and electric shock might also lead to accidents. The first thing to be followed is that one should not panic and handle the situation in a more calm and composed manner. Some of the first aid procedures for accidents from the above mentioned sources are as under –
First Aid for accident caused by acid burn or contact:
Wash immediately with good amount of water preferably running water and in case of larger spills safety shower should be used.
After washing apply neutralizer or 5% sodium carbonate solution on skin and in case acid gets into the eye then administer 4 drops of 2% aqueous sodium bi-carbonate solution.
In case the acid is consumed then make the patient drink 5% soap solution or give him two egg whites mixed with 500 ml of milk or water. In the event of non availability of these two make the person drink lot of ordinary water.
Consult a physician.
First Aid for Alkali burns
Instantaneously wash with large amounts of water and do it repeatedly.
Once washed apply a 5% acetic acid or undiluted vinegar solution to the affected portion of the skin. In case the alkali has got into the eye then after washing use a saturated solution of boric acid and repeatedly pour drops in the eye.
In case the alkali has been swallowed then give a 5% acetic acid or lemon juice or diluted vinegar solution to the patient and after that make the person drink 3 to 4 glasses of ordinary water.
Refer to a physician.
First aid in case of Poisoning
In case of oral poisoning induce vomiting by making the patient drink warm salt water to drink and keep on repeating it till the vomit is clear. However in case of the chemical which the person has consumed is a acid, solvent or alkali or the person in unconscious then do not try to induce vomit. Call for medical aid immediately.
If the poisoning is caused by gas then instantaneously take the victim out of the affected area and make him or her lie down in a horizontal position. Consult a doctor urgently.
In the event of percutaneous poisoning, remove the contaminated clothes immediately and wash the affected region. Call for medical aid immediately.
In all the cases of poisoning, awareness of the toxicity of chemical substance can be helpful while administering medical aid.
Burns resulting from Heat
The burns that occur due to heat arising flames or hot liquids or explosions etc. can be majorly classified into two categories i.e. the major or severe burns where a large part of the body is affected and it is mostly 2nd or 3rd degree burn and the other is minor or small burns in which a small portion of the body gets affected and it is mostly a 1st degree burn.
In case of minor burns dip the affected part in ice cold water for some time and repeat the same. After that apply ointment on it.
Refer to a physician.
For major burns if the person is on fire then roll the person in a blanket to douse the flames. After that make the person lay down and try to calm him.
Call for medical help immediately and do not apply any medicine.
First aid for injuries resulting from broken glass
In case of small cuts or injuries wash the wound at the same time and try to remove glass pieces if any.
Apply mercurochrome or acriflavine ointment on it and cover the wound with gauze and adhesive tape.
In case of deep cuts or when there is plenty of bleeding then try to stop the bleeding by pressing down on it with a compress.
Call for immediate medical help.
Contamination by infected material
Injuries resulting from broken glassware which contained infected material or specimen fall under this category. For these types of injuries the advisable first aid is
Instantaneously wash the wound with clean water.
In case the cut is not bleeding then make it bleed by squeezing hard for a couple of minutes.
Using antiseptic lotion wash the complete area including the edges of the cut and the wound. After that wash it with soapy water and then again with antiseptic lotion.
Refer a doctor.
First aid in case of electric shock
Electric shock might result from faulty equipment or carelessness like using wet hands on electrical equipment etc. and can cause the person to faint or asphyxia. In such a case first switch off the main switch.
Immediately start giving mouth to mouth respiration.
Call for medical help simultaneously.
Every laboratory must have the first aid equipment which includes,
1. First Aid Box containing instruction sheet with general guidance, sterile adhesive dressings in different sizes, a bottle containing eye drops, scissors, sterile eye pads, safety pins, antiseptic lotion, sterile eye pads and first aid manual.
2. Sodium Carbonate 5% solution.
3. 2% sodium bi-carbonate solution
4. Boric Acid saturated solution.
5. Antiseptic lotion
6. Soap powder solution (per liter of water add 5g)
7. 5% Acetic acid solution
8. Cotton wool and gauze
9. Rolled Bandage
10. Adhesive tape
11. Mercurochrome and iodine tincture.
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1.6. CLEANING AND CARE OF GENERAL LABORATORY GLASSWARE AND EQUIPMENTS
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Cleaning of Glassware:
For getting successful results from the experiments performed in a laboratory it is essential that the glassware gets perfectly cleaned. However cleaning of laboratory glassware is not a very easy task. Glassware has to be clean physically, chemically as well as free of any germs. Much of the time, detergent and tap water are neither required nor desirable. You can rinse the glassware with the proper solvent, and then finish up with a couple of rinses with distilled water, followed by final rinses with deionized water.
Washing Glassware:
Rinse the glassware with the appropriate solvent. Rinse with other solvents as needed, followed by ethanol and finally deionized water. If the glassware requires scrubbing, scrub with a brush using hot soapy water, rinse thoroughly with tap water, followed by rinses with deionized water.
Some of the commonly used lab glass wares are:
Burette:
Wash with hot soapy water, rinse thoroughly with tap water, and then rinse 3-4 times with deionized water. Be sure the final rinses sheet off of the glass. Burettes need to be thoroughly clean to be used for quantitative lab work.
Pipettes:
The glassware is soaked overnight in soapy water. Clean the pipettes using warm soapy water. The glassware may require scrubbing with a brush. Rinse with tap water followed by 3-4 rinses with deionized water.
Volumetric Flasks:
Wash the flask with soapy water and then rinse 3-4 times with deionized water.
Glassware should be allowed to air dry on the shelf. It should not be dries using a paper towel or forced air since this can introduce fibers or impurities that can contaminate the solution.
If glassware is to be used immediately after washing and must be dry, rinse it 2-3 times with acetone. This will remove any water and will evaporate quickly.
Glass Slides & Cover Glass
Slides should first be washed, and then placed in solution containing glacial acetic acid for around 10 minutes. Afterwards the slides and cover glass are thoroughly rinsed with distilled water and then wiped perfectly dry using paper towels or clean cloth. As soon as this is done they should be placed in a wide jar containing alcohol.
Culture Tubes
Culture tubes should be sterilized prior to cleaning. Culture tubes should be autoclave it for half an hour at around 121°C (15 p.s.i. pressure). The tubes when emptied must be brushed with water and detergent and then rinsed with running tap water. After this it should be rinsed with distilled water, and placed properly for drying.
Detergents used for washing
Most detergents are very effective for most cleaning problems encountered. However for best results the detergents made especially for laboratory glassware must be used. Some of the commonly used detergents are sulfuric dichromate and acid-alcohol.
Maintenance of Equipments
The increasing level of technical sophistication and complexity found in clinical laboratory instrumentation today more than ever demands careful attention to maintenance service needs. The time-worn caution for careful definition of requirements for acquisition of a system should also carry over to maintenance & service of these equipments. Certain common type of laboratory equipment and their proper usage & care is as under:
Microscope –
Microscope the most vital equipment in the laboratory which is used for magnifying a small object or image by 100, 400 or even 1000 times of the original size. Microscope is made up of two words – micro & scope wherein micro means small and scope means to view. A laboratory may have various microscopes depending upon what is their power, usage etc. Being aware of the importance of microscope its care and cleaning must also be give due importance so that the equipment gives correct results. Some of the cleaning procedures to be followed are –
Dust should be cleaned off with pressurized air or with a soft brush
Clean smudges, fingerprints, oils, etc from the lens with clean lens paper or a soft clean cloth moistened with a small amount of absolute alcohol-ether mixture. If an alcohol-ether mixture is unavailable, use isopropyl alcohol
Clean the microscope body and stand using a moist, soft cloth with a small amount of detergent.
Working temperatures are: 32° F-104° F (0°C-40°C). Max. relative humidity: 85%
Use water only on plastic surfaces
Do not use paint thinner or other solvents
Do a final wipe with a moist soft cloth
Dry all surfaces after cleaning
Besides these cleaning processes the daily care which must be ensured while handling the microscope include –
Always cover the microscope with the supplied dust cover when not in use
Store in a dry place
In humid or moist environments, it is advisable to store the microscope in a waterproof container with a drying agent
Do not touch the optical lens with bare fingers
Do not store the microscope in direct sunlight. Sunlight can influence the quality of the specimen imaging.
Lift the microscope with both hands.
As almost all the procedures of a medical laboratory require the use of microscope so as such handling it in a proper fashion is mandatory.
Photometer or Calorimeter –
The photometer is a device which is used to measure optical density or color intensity or absorbance of solutions. Based on the arrangement of obtaining monochromatic light, the photometers are categorized as filter photometers or spectrophotometers. The normal precautions to be observed while handling photometers are as under –
Do not pour out samples or prepare the tests directly over the instrument.
Always cap the test tubes after preparing the blank and test sample.
Wipe test tubes with a clean tissue to remove drips or condensation before placing in the photometer.
Do not leave tubes standing in the photometer test chamber. Remove the tubes immediately after each test.
Immediately wipe up any drips or spills on the instrument or in the test chamber with a clean tissue.
Keep the instrument clean. Clean the test chamber regularly using a moistened tissue or cotton ball.
Keep the instrument away from all chemicals and cleaning materials.
Keep the instrument in a clean, dry place when it is not in use. Keep it on a clean, dry bench away from chemicals, place it in a storage cupboard or keep it in a carrying case.
Keep the carrying case in a clean, dry condition. Make sure that the carrying case is dry before the case is closed up and the instrument is put away.
Centrifuge –
A centrifuge is a an equipment, generally driven by an electric motor or spun by hand, that puts an object in rotation around a fixed axis, applying a force perpendicular to the axis. The centrifuge works using the sedimentation principle, where the centripetal acceleration causes more dense substances to separate out along the radial direction. By the same token, lighter objects will tend to move to the top. There are various types of centrifuges –
preparative centrifuge
analytical centrifuge
angle fixed centrifuge
swing head centrifuge
haematocrit centrifuge
Industrial centrifuges may otherwise be classified according to the type of separation of the high density fraction from the low density one
Screen centrifuges, where the centrifugal acceleration allows the liquid to pass through a screen of some sort, through which the solids cannot go (due to granulometry larger than the screen gap or due to agglomeration). Common types are:
Pusher centrifuges
Peeler centrifuges
Decanter centrifuges, in which there is no physical separation between the solid and liquid phase, rather an accelerated settling due to centrifugal acceleration. Common types are:
Solid bowl centrifuges
Conical plate centrifuges
In order to ensure proper working of the equipment certain care and maintenance procedures should be followed like –
Inspect the centrifuge chamber for accumulations of sample, dust of glass particles from broken glass tubes and clean appropriately to ensure that no unwanted particle is left in the chamber.
Centrifuge tubes made of strong glass must be used in the machine.
The centrifuge speed should be increased gradually.
Disinfecting centrifuges is very necessary to maintain the precision of the tests being carried out.
Take proper care of the rotor in terms of cleaning and keeping it scratch free by not using steel wool, wire brush or abrasives etc for cleaning.
Never pour water directly into the sample chamber.
Autoclave –
An autoclave is a device to sterilize equipment and supplies by subjecting them to high pressure steam at 121 °C or more, typically for 15 to 20 minutes depending on the size of the load and the contents. There are mainly two types of autoclaves –
Stove Type Autoclave
Front Loading Autoclave
Following are recommendations for the care and use of autoclaves –
The steam should be saturated and free from corrosion inhibitors or other chemicals, which could contaminate the items being sterilised.
All materials to be autoclaved should be in containers that allow ready removal of air and permit good heat penetration; the chamber should not be tightly packed or steam will not reach the load evenly. Bags should allow the steam to reach their contents.
For autoclaves without an interlocking safety device that prevents the door being opened when the chamber is pressurized, the main steam valve should be closed and the temperature allowed to fall below 80C
 

Medical Advancements during the Industrial Revolution

Compared with the other great time periods, the industrial revolution in particular was known to have had one of the largest impacts on the world. Some of the largest being advancements in technology leading to breakthroughs in the field of medicine. It was during the 18th century that scientists were able to discover cures for many previously incurable diseases through the use and application of these “new” technologies. The government of the time was also forced to improve living conditions in order to create better sanitation, which in turn also helped to lower the risk of disease and raise life expectancy.

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Disease accounted for many deaths in industrial cities during the Industrial Revolution. With a chronic lack of hygiene, little knowledge of sanitary care and no knowledge as to what caused diseases (let alone cure them), diseases such as cholera, typhoid and typhus could be lethal. As the cities became more populated, the problem worsened. Prior to advancements in medicine there had been little-to-no sanitation, and accordingly people living during this time had a very short life expectancy. Also, there was little understanding around how and why disease was constantly spreading. One of the major contributing factors was the housing conditions which the majority of the population dwelled: they were overcrowded, meaning that one small room could (and often did) house up to ten people. Houses did not have access to clean water, the water was contaminated with sewage, bacteria and other pathogens. With the majority of doctors knowledge being based upon traditional remedies that had little evidence, and there being limited diagnostic tools or understanding, this also did not help the health of the population. Before and during the industrial revolution there was a common belief that disease was caused by “bad smells” and “invisible poisonous gas clouds.” With increasing numbers of people within cities, diseases and ill-health was on the rise, which promoted scientists to begin searching for scientific reasons behind diseases and thus deducting how to cure them.
Throughout the industrial revolution there have been accounts of poor living conditions coupled with bad building management systems, mass siltation and poor hygiene. FRIEDRICH ENGELS was known to have said ‘In one of these courts there stands directly at the entrance, at the end of the covered passage, a privy without a door, so dirty that the inhabitants can pass into and out of the court only by passing through foul pools of stagnant urine and excrement.” (Cotton times, 2012).This quote from his memoir shows the extent of pollution and the mismanagement of waste disposal. This also shows just how filth stricken and unhygienic the streets where. This abundance of pollution and waste was defined aided the spread of disease.
Until the occurrence such medical advancements surgery and other medical practices remained a task frequently done by barbers merely because they possessed the correct tools. The lack of any such pain killers, along with the continuing social disapproval due to such mortalities, created a continuous cycle where few people underwent surgery thus leading to limited knowledge and research done in the field. Therefore surgery and medicine in general progressed very little throughout the middle ages and all of that changed in the industrial revolution due to revolutionary medical advancements.
It all began with the discovery of the properties of chloroform and ether in the 1850’s by numerous scientist, thus making surgery effectively painless, though there was still a significant amount of pain after the effects of the anaesthetic wore off. On screen is a chart that shows the evolution of surgery and medicine in general. Even knowing this the number of people willing to undertake surgical procedures multiplied in the following years. This caused the increase of the death of patients post operation presumably due to bacterial infection. In the decades prior such a small quantity of people were willing to undergo surgery and the patients that did most likely died on the operating table therefore bacterial infection was relatively rare and thus their causes such as operating conditions, unclean surgical instruments as well general poor hygiene where remained unexplored. After countless deaths and a plethora of research came the answer: germs
In the 1850s Louis Pasture make a significant breakthrough with his revolutionary germ theory of disease. He discovered the microorganisms were causing decay because they were constantly spreading. He concluded that these microorganisms where the cause of many diseases. He carried out his experiments by collecting air in flasks and determining which ones contained more bacteria. The flasks that had more bacteria were noted as containing air from places that had been very overpopulated and dirty. He extended his theory to explain the causes of many deadly diseases such as anthrax, cholera as well as TB. Now scientist could cure sicknesses based on the discoveries made by Pasture. Without Louis Pasteur the field of microbiology would not have existed. His contributions where crucial to the development of the Industrial Revolution and his discoveries are still relevant to this day. They have acted as building blocks for further discoveries and started a general trend in medicine. His contributions include, instituting changes in medical practices, to minimize the spread of disease, discovering that weak forms of disease could be used as an immunisation and finally he introduced the concept of viruses to the medical world. Because of his glowing accolades many regarded him as the “father of microbiology”. Personally I believe that he deserves such title because without his work many of modern medical discoveries would not have occurred but I do accredit him solely because I believe that the advancements made in the industrial revolution where a group effort and that many scientist contributed to its occurrence.
Although his research was neglected by the medical community for several years due to his unorthodox methods of practise, Edward Jenner revolutionised the study of medicine forever by creating a cure for Smallpox which has changed the practise of the prevention of many diseases with vaccines today saving countless lives. He built upon the work done by Louis pasture and created a vaccine for smallpox by inoculating his patients with cow pox. It was successful and became mandatory in Britain in 1852. With economic growth living standards were able to improve. Britain was able to turn the field of public health into a socio-medical vital to community health. Soon enough the new chapter of the revolution included focussing on the public health movement and supporting the poor who were unable to pay for medical treatment. So the Public Health Act was passed, making sanitary improvements in the slums and stationed medical officers in every district in England. Infant mortality rates where decreasing and life expectancy was finally flourishing. After several medical findings such as relief from typhoid and surgery started to become widely practised.
In order to have surgery patients need to go under anaesthesia. To create anaesthetics mixed numerous chemicals and experimented to find out what effects they would have on humans. Humphrey Davies realised by experimentation that laughing gas was one factor that could reduce pain. Since this wasn’t the most effective method therefore ether was used due to its ability to put patients to sleep. In 1847 James Simpson was the first to discover chloroform’s ability to render patients unconscious. With this medical breakthrough surgery was able to become a quicker and a more efficient process. A problem with early surgery was that surgeons did not poses antiseptics this caused infections in patients and many deaths.
Joseph Lister discovered that spraying patient’s wounds with carbolic acid spray would kill microbes thus preventing the occurrence of infection and allowing the patient to heal correctly without infection. His spray was eventually used in public places as a sanitary precaution but some individuals at the time reported to having reactions to this acid.
In 1895 Wilhelm Röntgen discovered the use of x-rays in medical imaging, this brought great advancement to the medical world and surgery itself. Without such a discovery the world’s medical history would not have been the same. All of these inventions and progressions in medical technology have paved the way for a successful medical world as we know it. The machines, drugs, surgeries have all originated from the time of the industrial revolution. Of course they have progressed and evolved over the years and will continue to evolve as time goes on. If there was never a revolution such as this one the world would have never seen change. Our lives and lives to come will forever be different due to the medical advancements in the industrial revolution.
The industrial revolution was a turning point in history because its medical advancements improved health in the medical word, life expectancy and the spread of disease. There are many points that be argued as the most important part of the industrial revolution and turning points in history.
Although many historians like to say that the advancements in medicine where not as crucial to the occurrence of mass industrialisation as agriculture, per se. While I acknowledge their points and am in no way saying that the changes in agriculture was not important but I believe that the medical advancements and the change in legislation due to these advances where crucial to the continuation and sustainability of the industrial revolution. Because, a healthy workforce is a productive workforce. Without a healthy workforce industrialisation could not have occurred and workplace based injuries would not have been able to be treated and in the case of the agricultural revolution
While some people today like to focus on the work of just one person as “the” breakthrough which influenced the remainder of the Industrial Revolution, and as such shaped the medical field as we know it today, however, I disagree. I do not think it is possible to name just one man as the founder of modern medicine. Each of the scientists that I have named had unique contributions to the field, each independent of the other. Without any one of these, there would still be disease and ill-health throughout the world. To name just one man would be an injustice, thus I acknowledge each of these breakthrough scientists for their contributions and efforts to enable myself to live the safe and healthy life that I do today. I believe the most productive work that aided humanity has been done in collaboration throughout history. I believe that these advancements where a sheer coincidence and the correct number of scientist gathered at the right time under the correct circumstances lured by economic opportunities.
The medical advancements in the industrial revolution caused the worldwide improvement in life expectancy and public health. That world wild phenomenon had a domino effect throughout the following years and lead us to where we are today. Without the industrial revolutions medical advancements we would not be in the position we are in today with public health and life expectancy.
 

Medical Equipment Sales Ethics

Ethical Leadership

Many believe ethics and morals are interchangeable; indeed, there is a blurred line between the two. However, morality is a personal belief that individuals create and develop for themselves to govern their life. Ethics is a physical statement, or law, that defines how businesses and people should act toward each other. There are many qualities that define an ethical leader. Honesty, humanity, respect for others, fairness, encouragement of subordinates, and having no tolerance for ethical violations are characteristics of an ethical leader.

Leaders can appear in a myriad of ways across many platforms that range from business to politics, even celebrities can use their personal influence to state what an ethical leader should do by the way they act and how they treat other people. 

Business Ethics

According to a 2016 study, salespersons of durable medical equipment (DME) are nearly always in the operating room with the surgeon to ensure the proper instruments are used during the surgery (O’Connor, Pollner, & Fugh-Berman, 2016). In this scenario, I am uncomfortable with the idea of withholding information about the potentially fatal side effect but am bound by a non-disclosure agreement I signed that forbids me to say anything.  The goal becomes how to balance my personal morality, following ethical business standards, and keeping my job. To achieve this standard I look to emulate other leaders that exemplify my beliefs.

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One Leader I look to as a role model is G.L. Like many ethical leaders, G.L. displays all the aforementioned traits; however, he demonstrates two particular traits very well. The two ethical traits are respect for others and care for humanity. These ethical traits stem from a strong belief in the Declaration of Independence where it is mentioned that all people are equal and gifted with undeniable rights which are life, liberty, and the pursuit of happiness (U.S. National Archives and Records Administration, n.d.).

G.L. organizes and promotes conversation, and deferential debate, between people and groups of opposing opinion without allowing petty dialogue or personal attacks. It is his belief that we need diversity in life, especially business, to succeed. He shows respect for others by allowing people to have their own opinion; and, by accepting people and not trying to change their beliefs he tries to find common ground in which to build a relationship. I have seen in my own life that it is easier to accomplish goals with people I would otherwise not associate with by having a few common points of interest and building trust through those means.

G.L. has helped create and establish an organization based on humanitarian beliefs. The mission of this organization is to free the imprisoned, welcome the incarcerated, and to liberate, reconstruct, reestablish, and improve the lives of persecuted religious and ethnic minorities wherever they are in need; second, is to interrupt human trafficking in an enterprise called Operation Game Changer (OGC) (Mercury One, 2018). There have been over100 campaigns in the Middle East since this organization was founded in 2015; and, during Super Bowl LI, OGC identified over 40 locations in the Houston, TX area involved in human trafficking (Mercury One, 2018).  Both situations show that G.L. believes in basic human rights for everyone; nobody should be forced to follow the beliefs of the country in which they live, nor, should they be forced into slavery. Much like the underground railroads during the civil war these companies move under the cover of darkness using side roads and safe points to get these people to safety.

Ethical Consequentialism

Many people misunderstand consequentialism as any action being acceptable so long as the results are good; however, this is an extreme view of consequentialism because there is no way to define what a morally good result would entail (Frecknall-Hughes, Moizer, Doyle, & Summers, 2017).  Consequentialism is more complex by insisting on equality between the means in which things are done and the end results; in this sense, an unlawful act would be permitted to maintain the balance of situation so that a projected good outcome might still be achieved (Frecknall-Hughes, Moizer, Doyle, & Summers, 2017). The idea, the needs of the many far outweigh the needs of the individual, is similar to the consequentialist core belief. Ethical consequentialist judges a person’s actions based on the outcome of the situation and how it affects the individuals involved.  If a majority experience a positive feeling or achieved a positive outcome, then the situation was morally and ethically correct.

An ethical consequentialist in this scenario might not feel obligated to disclose the potential for a lethal side effect. As previously described, consequentialists judge a person’s actions based on the outcome of the situation. A sales representative with an ethical consequentialist attitude would ensure their presence in every operation that involved the artificial knee-joint so they would have the opportunity to maintain the balance of the situation and ensure the most positive outcome for all people involved.

An ethical consequentialist will view cognitive moral development as something that is mutable; dependent on the situation it may be required for the individual to act differently at different times to ensure a balanced outcome. Since perspective is completely the truth for the one that beholds it, it can be argued that any ethical position is postconventional. As it relates to society and justice a consequentialist would follow this same pattern because they believe their principles transcend mutual benefit and a standard set of rules regarding overall outcome would make life better and fairer for all.

However, in certain situations this may change. If asked, is it better to honor your company’s non-disclosure agreement or inform the potential buyer of the risk involved, a consequentialist may adopt a conventional attitude to try and keep friendly relations between the surgeon, the patient, and their company; indeed, they will believe in following the rules to maintain the order. Currently there are no ethics laws pertaining to the sales of durable medical equipment (DME) that force companies to provide full disclosure on the products they sell to the general public. The law as it is written in Executive Order 12731 states, “manufacturers, governments, and entities that do business with the government are to put forth fair and rigorous standards of ethics (U.S. Department of Health and Human Services, 2018).

Since there is no law requiring full disclosure, a consequentialist would not worry about being dismissed from work; for the greater good, they would not mention the fatal side effect. They may, however, wonder if they will receive additional compensation beyond the regular sales commission for maintaining their company’s policy to avoid disclosing information regarding a potentially lethal infection. In this instance, looking for personal gain, an ethical consequentialist thinks on a preconventional stage of development.

Ethical Deontology

An ethical deontologist believes the morality of a person’s action is more important than the outcome; contradictory to the consequentialist, a deontologist will not allow an unlawful act to occur while trying to attain their goal (Mandal, Ponnambath, & Parija, 2016). While the end result is to sell knee replacements and make life better for those individuals that need them, a deontologist would not feel comfortable withholding information; indeed, most deontologists view withholding information tantamount to lying. Lying is dishonest and therefore not a morally acceptable way to conduct business. If I were an ethical deontologist, I would have no problem disclosing all pertinent information regardless of the non-disclosure agreement; furthermore, as a deontologist I would have refused to sign the non-disclosure agreement citing that withholding information, such as the possibility of death, is morally reprehensible and at its core lying to our customers.

Like a consequentialist, a deontological thinker would move through different stages of moral development. An ethical deontologist would have a post conventional view on what is best for society, overall justice, and what their interpretation of the law is regarding whether or not they are obligated to say something; as a post conventionalist they would see morality and legality are not always the same but, practical rules should occur to make life fairer for everyone. They also would want a society where principle, such as honesty, transcended mutual beliefs.

An ethical deontologist does not look for personal gain over doing what is right. This person would be in the conventional stage of morality based on their orientation to understanding that having fixed rules keeps society in order. They understand their company’s policy is to not disclose the potentially fatal risk, however, their reasoning for morality and their belief in honesty would make them want to disclose that information to maintain order in society.  A deontologist would not expect additional rewards if they honored the non-disclosure agreement; in fact, they might challenge the non-disclosure agreement citing the lack of morality, even, dishonesty with their customers and potential customers. Because of this they may fear losing their position within the company related to differences in moral beliefs.

 

A Critique of My Ethical Lens Inventory

As I was researching what it meant to be a deontologist versus a consequentialist I learned more about how I think ethically. It makes sense that I lean towards consequential ethics as I use reason and experience to determine what ethical priorities are needed to provide guidance in any situation.  I am a person that is regularly categorized in the two percent of any given group and the results of my Ethical Lens Inventory (ELI) did not surprise me; am in the special two percent of ethically ambivalent people. While I do fit into the two percent margin I am just off center in the reputation lens. My ELI shows that I have a mild preference for sensibility and equality. In situations that are not clearly defined I lean toward my feelings rather than rationale. I also have respect for the community. This is true in all settings of my life. I compartmentalize my surroundings, that is to say, work is one community, my family is another community, and my social life is yet another. I act the same ethically in each situation.

Ethical Flaw: The Double Standard

In examining the negative aspects of Ethical Lens Inventory (ELI) I chose to further explore my double standard. Apparently, I have a double standard that reflects a sense or entitlement; which is to say, I believe that my status entitles me to perks that are not, or should not, be available to people not in my position. As I read more about this I can see myself at work. The ELI suggests when I think about, or about to attempt, something unethical I use my position as a means to progress. It also suggests I believe that I am my position. This is true of my beliefs as it relates to work. Where I work I assist in many departments; in fact, I know more about what is going on in the entire building between human resources, inventory supply, and,  expenditures I believe that if I was no longer there the infrastructure of the building would collapse, and for a time, be in complete disarray; because of the many functions I fill, it would take at least three people to replace me. The question then becomes, what can I do to mitigate this attitude and what steps I need to take to ensure I do not let myself fall victim into other negative aspects of my ELI.

The first step is to recognize this as a flaw in my ethical thinking and actions. This must be followed by understanding; that is, I need to understand how this ethical thinking can lead my actions and how others perceive me. As part of that understanding, I need to learn about the different ethical lenses to understand how to interact with them in a positive manner.

Second, I need to consider the individuals I interact with. Whether it is at work or in social situations I need to support those around me and respect their position. Rather than believe they are where they are, or know what they know, is because of me I need to step back, realize they understand their job and then help to edify them in their position.

The third thing I can do is develop ethical agility. This step can be achieved as I master the first two steps. Once I have learned and understood other ethical lenses and use that knowledge to help others around me I can then fulfill this step; which is to move between ethical lenses fluidly dependent upon circumstances, thus helping me transform into a person that views actions more importantly than outcomes.

Values and Virtue

As stated earlier, I value sensibility and equality. According to my Ethical Lens Inventory (ELI) my emotions are controlled by my reason as I look to fulfill what my heart desires most. I lean toward the good of the community over the need of each individual. I see this in how I support local institutions, whether government or privately owned, so long as they are good for the community and no entity abuses their authority by taking away individual choice.

My classical virtue is fortitude. My Ethical Lens Inventory (ELI) defines me as a person that bears hardship and uncertainty with courage. I can definitely see this in how I act and react to the situations that go on around me. As I work to complete goals I am faced with obstacles from time to time; however, I do not let this stop me. Some would call, and have called, this attitude being stubborn; but, I know now that this is my classical virtue of fortitude.

Conclusion

Ethics is a physical statement, or law, that defines how businesses and people should act toward each other. There are many qualities that define an ethical leader. Honesty, humanity, respect for others, fairness, encouragement of subordinates, and having no tolerance for ethical violations are characteristics of an ethical leader. An ethical consequentialist will view cognitive moral development as something that is mutable; dependent on the situation it may be required for the individual to act differently at different times to ensure a balanced outcome. An ethical deontologist believes the morality of a person’s action is more important than the outcome; contradictory to the consequentialist, a deontologist will not allow an unlawful act to occur while trying to attain their goal (Mandal, Ponnambath, & Parija, 2016). Through personal reflection, and the things I have studied for this essay, I look to become more ethically deontological. I believe it is important that my actions be above reproach. Knowing my ethical strengths and weaknesses will help me achieve the type of professional is important. I know having fortitude as my virtue I understand how negative actions can affect outcomes and this will help me to know how to guide my actions to promote positive outcomes. Knowing where I stand on the ethics spectrum will help guide me in everything I do.

References

Frecknall-Hughes, J., Moizer, P., Doyle, E., & Summers, B. (2017). An examination of ethical influences on the work of tax practitioners. Journal of Business Ethics, 146(4), 729-745. Retrieved from http://eds.b.ebscohost.com.wgu.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=ede06ed1-5b50-418c-afa6-7165b7a62cdd%40sessionmgr120

Kohlberg, L. (1971). Stages of moral development. Moral education, 1(51), 23-92. Retrieved from http://info.psu.edu.sa/psu/maths/Stages%20of%20Moral%20Development%20According%20to%20Kohlberg.pdf

Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical parasitology, 6(1), 5. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778182/

Mercury One (2018) Restoring the Human Spirit. Retrieved from https://www.mercuryone.org/humanitarian/human-spirit/

O’Connor, B., Pollner, F., & Fugh-Berman, A. (2016). Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives. PLoS ONE, 11(8), e0158510. http://doi.org/10.1371/journal.pone.0158510

U.S. Department of Health and Human Services (2018). Principles of Ethical Conduct. Retrieved from https://www2.oge.gov/web/oge.nsf/Executive%20Orders/25792F3D2FF647AF85257E96006A90F1/$FILE/f69da5359a134002808b96ca703cc4692.pdf?open

U.S. National Archives and Records Administration (n.d.) Declaration of Independence: A Transcription. Retrieved from https://www.archives.gov/founding-docs/declaration-transcript.

 

Mary Greenley Medical Center: Business Model Evaluation

Background Information
Mary Greenley Medical Center (MGMC) was gifted to Ames, Iowa in 1916 by a Union Army officer in the Civil War named Captain Wallace Greeley. He gifted the hospital in memory of his wife Mary Greenley. MGMC is a public, nonprofit hospital and is the largest independent medical center in its primary and secondary markets. The hospital supplies 220 beds offering a wide range or medical services such as cancer care, surgery, mental health service and rehabilitation. MGMC provides health care to residents of a 13-county area in central Iowa (“About Mary Greeley Medical Center”, 2020).

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Critical Evaluation
A company’s strategy is the set of actions that its managers take to outperform the company’s competitors and achieve superior profitability (Thompson, Gamble, Peteraf, & Strickland, 2018). The strategic decision that led MGMC to winning the Baldrige Performance Excellence award was making their mission, vision, and values a huge foundation in their strategic plan. MGMC focuses on four goals which are serious safety events, employee engagement, patient engagement, and net operation margin. Another strategy of MGMC was by offering different programs within the hospital, focusing on the patient’s needs, and having patient access. A wide range of programs like cancer care offered patients to seek medical support for MGMC because not only could they get everyday medical care there but also had specialty care that is harder to find.
Business Model
A company’s business model sets forth the logic for how its strategy will create value for customers and at the same time generate revenues sufficient to cover costs and realize a profit (Thompson, Gamble, Peteraf, & Strickland, 2018). MGMC focuses on making the community that surrounds them as their primary stakeholder. They also include the community in their strategic planning. This gives them an advantage over their competition because the community believes in their vision. One of the missions of MGMC is to provide the most cost-effective health care services while still making sure all the needs of the patient is met.
Competitive Advantage
MGMC has maintained competitive advantage over their competition. Competitive advantage whenever it has some type of edge over rivals in attracting buyers and coping with competitive forces. (Thompson, Gamble, Peteraf, & Strickland, 2018). MGMC differentiates itself from other hospital in a number of ways. Above all MGMC focuses on their patients. More than 75% of inpatients and outpatients would recommend MGMC to others and has also outperformed local competitors in top-of-mind hospital recall, preferred hospital, and brand power index (“About Mary Greeley Medical Center”, 2020). They also outperform in the areas of hospice care, and home health care. One reason they maintain this advantage is by believing and focusing on the vision of “Doing What’s Right”. MGMC also focuses on adjustments in financial decisions over time. They have sustained Medicare spending per beneficiary at or close to the CMS top decile for four years. The maintain under budget for cost per adjusted admission and net revenue has remained stable over six year even with a tight labor market.
Sustainable Competitive Advantage
MGMC develops a sustainable competitive advantage by being a low-cost provider, a broad differentiation,
Vision, Mission, and Values
MGMC has a strong mission, vision and values that is Mission: To advance health through specialized care and personal touch. Vision: To be the best. Values: PRIDE in the quality of care we provide to our patients, visitors and families – People-oriented Respectful Innovative Dedicated Effective. These mission, vision and value statement works for MGMC because it is believe my everyone from the top leaders of the company to the employees and ever throughout the community.
References

About Mary Greeley Medical Center. (n.d.). Retrieved from https://www.mgmc.org/about/
Thompson, A. A., Gamble, J. E., Peteraf, M. A., & Strickland, A. J. (2018). Crafting and executing strategy: the quest for competitive advantage: concepts and cases. New York, NY: McGraw-Hill Education.

 

The medical coding

The Performance of Medical Coding
What responsibilities are required in Medical Coding? How is Medical Coding beneficial in the healthcare industry? Herzing University (2009) says, “Medical Coding is the act of billing patients and health insurances for the medical checkup they received.” Medical Coding is one of the most valuable careers in the Healthcare industry. However, this profession requires important guidelines, such as assigning proper health-related codes, understanding coding language, and meeting the terms of the compliance rule. Moreover, as a productive benefit in this line of work, many employers allow medical coders to enter codes from home.

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The first rule that applies to Medical Coding is the importance of code assignments. After a patient is seen by a physician in an office or hospital room, the medical coder’s job is to assign the appropriate health diagnosis code on the claim form. The claim form is to be submitted to the patients’ insurance company for reimbursement purposes; claims are submitted to insurance companies so that doctors will be paid for the services rendered in the office as well. Upon submitting the claim form(s), it is important for the medical coder to assign the correct code(s) to ensure a timely payment process. If the code(s) are incorrect, this will cause the claim to be denied and payment will not be released until the issue is corrected. Herzing University (2009) comments that “Every medical diagnosis or procedure that is done in a medical office should have a health-related code assigned to it. The medical coder is accountable for assigning the correct code for each procedure that is performed on a patient.” In addition, AHIMA (2009) predicts that “the excellence of medical services depend on if a medical coder assigns codes accurately and in a timely fashion.”
   In Medical Coding, the first and foremost responsibility is to make certain that the payment reviews and funds flow effectively. Scichilone (2008) also points out that “the timely completion of assigned codes depends on the accuracy of the coding process.” Therefore, assigning proper codes for medical procedures are essential because it will guarantee timely payment to medical providers and their patients’.
Another rule that applies to Medical Coding is the understanding of coding language. Where does the resource of coding come from? Who maintains the health-related coding system? The American Health Information Management Association (2009) clarifies that “the resources for the health-related coding are maintained by a particular group of organizations. These groups are responsible for the updates and or changes for the coding process. The National Center for Health Services, is in charge of the ICD-9-CM codes, whereas, The American Medical Association is responsible for the CPT codes.” What is the coding language and why is it used in Medical Coding? In Medical Coding, an ICD-9-CM code is entered on a claim to code a patient”s diagnosis received from the physician. In addition, there may be more than one diagnostic code on a claim form. A CPT code is entered on a claim to code a procedure that was performed on the patient(s). There may be more that one procedure code entered on the claim form as well. For simplicity principle, the codes assigned convey what types of service(s) were provided and why the procedure was done. Rogoski (2004) adds that “[t]here are two major coding [organizations that are responsible for the coding language],..: the ICD-9-CM diagnosis and procedure codes that are maintained by the federal government, and the CPT procedure codes that are maintained by the American Medical Association.”
For verification purposes, American Medical Association (2009) define the definition of the diagnosis code ICD-9-CM is “The International Classification of Diseases, Ninth Revision, Clinical Modification,” while (CDC, 2009) notes that the CPT procedure code means “Current Procedural Terminology.”
The most important rule that applies to Medical Coding is the consistency of data entries. Being that coding information is updated on a quarterly and yearly basis by the health care organizations, it is important for the medical coder to enter the updated or revised codes accordingly. Entering the correct diagnosis and procedure code(s) is essential because the code(s) determine how and why reimbursement or payment is requested. During the coding process, it is imperative for the coder to obtain the up-to-date information on medical services covered by the patients’ insurance company to avoid questionable outcomes. In other words, the services that are covered under a carrier should match what is documented in the compliance guidelines and if the coding or documentation is not consistent with the specific guidelines, this can develop into an investigation and claim rejections. AHIMA (2009) contends that, “Entering the appropriate data according to the compliance rule is very important in the coding process. Whether the codes are entered correctly or not, it will in one way or another, affect both the quality of the statistics and the fulfillment to the regulations.” For that reason, to stay current with the array of coding rules, the Medical Coder should always consult with the healthcare guidelines upon entering the code(s) on a claim form ensure the quality of medical information.
Furthermore, to ensure data consistency according to the compliance rule, meticulous medical coding software has been utilized to assist the medical coders during the coding process. “Computer-Assistance Coding” is how (Scichilone, 2009) describes the software. Even though coding can be complicated especially when trying to remember and stay up to date with guidelines, the use of medical coding software will promote thorough and affirmative results. Scichilone (2009) explains that “[t]hose little numbers or alpha-numeric [series] are one of the reasons the compliance [organization] exists.” The coding process is to note what type of medical service was provided and the reason for the office visit. To acquire efficiency, new software has been executed to help providers concerning data consistency guidelines. Medical coders can use this specific computer software to produce organized health codes for evaluation.” Not only does this medical coding software assist in positive reviews from the compliance group, it encourages moral standards as well.
As an added guideline precaution, healthcare providers are should distribute the compliance rule list within its facilities to ensure proper and precise coding. The list should include a detailed medical coding policy that must be adhered by accordingly. One author (Stegman, 2009) notes that “[f]or many clinical areas with commonly provided services, very specific coding and billing guidelines exist to assist the provider in reporting accurate and honest claims… Ideally, the provider should have a coding compliance policy document with…the following [factors]…”

Instructions on how to assign codes for new medical procedures;
Instructions on how to correct inaccurate codes that were previously assigned;
Code of conduct requirements linked to the Healthcare service provided,
Annual or semi-annual training in Healthcare compliance guiding principles,
Disciplinary steps taken if failure to comply with the guidelines occur, and
Helpful contact phone number to seek out additional or unclear information.

     In the Medical Coding position, these issues should provide helpful healthcare solutions when it comes to assigning medical codes for claim submission. By following these procedures, this will develop data quality within the healthcare environment because of the consistency assignment entries. Stegman (2008) agrees with these methods by saying that “coding experts are likely to sustain the importance of accurate and consistent coding traditions to deliver quality health care …Medical coders should continue to improve their coding skills to stay current with the coding regulations
The Medical Coder must maintain and follow the coding guidelines to avoid improper results with insurance companies and patients. If these compliance guidelines are not available by the provider, the medical coder(s) may have a difficult time assigning consistent codes. Stegman (2008) points out that “[w]hen coding challenges arise,… and unresolved documentation inconsistencies are present, the selection of the most accurate and compliant codes may be more difficult, particularly if the coding…staff are not aware of the [moral coding standards].” If the preceding coding process for Medical Coding is carried out appropriately according to the compliance guidelines, this will ensure data excellence.
Finally, while Medical Coding maintains specific guidelines to ensure effective results in the healthcare industry, many people are pursuing this type of work to take advantage of the flexible productive benefits. Many employers are allowing Medical Coding to be managed from home. To ensure that a Medical Coder generates efficient productivity from home, the “Computer-Assistance Coding” medical software that (Scichilone, 2009) described earlier, would be a very beneficial technology tool in the healthcare industry. Many health providers are providing its medical coders to work from home; working flexible hours and increase productivity are a couple of reasons why working from home is available. Flexible productivity (2004) states that “many healthcare corporations are engrossed with the productive benefits of flexibility working from home. By minimizing the demand of office space and reducing commuting time, the medical coder will gain flexible productive time and possibly get to manage their work-life obligations.” While the Medical Coder manages the medical software that was provided by their employer, on their home computer, the programmed software will generate assignment codes that are consistent with the compliance regulations. Scichilone (2009) says that the coding software will “increase… productivity in code assignment [, provide] consistent application of reporting rules and guidelines [,] and …monitor…[the] evaluation features for coding accuracy reviews.” Consequently, utilizing the coding software will provide added advantages in Medical Coding.
In conclusion, since Medical Coding requires specific guidelines for the healthcare industry to follow, it is imperative to abide by the compliance rules to avoid poor data standards. By entering accurate and thorough health-related data into the medical database, and obtaining a clear understanding of coding language and their resources, this cause of action will help the flow of the reimbursement process run effectively; as an added advantage, Medical Coding can be accomplished in the comfort of the medical coders’ home by way of compliance-ready medical software.
References

AHIMA About Medical Coding & Medical Records: (2009). Coding. Retrieved November 26, 2009 from http://www.ahima.org/coding/index.asp
AHIMA Medical Coding Guidelines:Data Quality and Compliance (2009). . Retrieved December 9 2009 from http://www.ahima.org/coding/compliance.asp
AHIMA Medical Coding Resources (2009). Coding Resources. Retrieved December 7, 2009 from http://www.ahima.org/coding/coding_resources.asp
AMA – CPT Code Information and Education (2009). American medical association. Retrieved November 28, 2009 from http://www.ama-assn.org/ama/no-index/physician-resources/3884.shtml
CDC – ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification (2009). Centers for disease control and prevention. Retrieved November 26, 2009 from http://www.cdc.gov/nchs/icd/icd9cm.htm
Flexible productivity.(2004). International Journal of Productivity and Performance Management,53(5/6),476-477. Retrieved November 30, 2009, from ABI/INFORM Global. (Document ID:695572871).
Medical Billing and Insurance Coding Overview (2009). Herzing university online. Retrieved November 23, 2009 from http://www.herzingonline.edu/programs/medical-billing-and-insurance-coding
Richard R Rogoski. (2004,September). If You’re Not Coding, You’re Not Billing.Health Management Technology,25(9),14, 16, 18. Retrieved December 7, 2009, from ABI/INFORM Complete. (Document ID:687678731).
Scichilone,R.(2009,July). Are We There Yet? Compliance-Ready Computer-Assisted Coding.Journal of Health Care Compliance,11(4),55-56,69-70. Retrieved December 7, 2009, from ABI/INFORM Global. (Document ID:1822883141).
Scichilone,R.(2008,July). Enhanced Compliance Results by Improving the Code Assignment Process.Journal of Health Care Compliance,10(4),61-64. Retrieved December 5, 2009, from ABI/INFORM Global. (Document ID:1670291831).
Stegman,M..(2009,September). Managing Billing Interpretations in a Compliance Environment.Journal of Health Care Compliance,11(5),65-66,77-78. Retrieved December 7, 2009, from ABI/INFORM Global. (Document ID:1882772921).

 

Imaging Techniques in Medical Science

Electrodiagnostics
Electrodiagnosis is the field of study that utilizes the science of electrophysiology. Specifically, electrodiagnostics study the human neurophysiology through the utilization of electrical technology. Neurodiagnostics, evoked potentials and electromyography are aspects of electro diagnosis.
Electromyography was the first electrodiagnostic examination to be developed. The procedure involves the placement of needles to several muscles to record various stages of muscle activity, minimal contraction, maximal activity and even rest. A normal muscle is electrically silent when at rest. Spontaneous depolarization of individual muscle fibers results from damaged muscle tissue. The mentioned alterations can be detected through the needle examination portion of electrodiagnostic examination. [122]
No special preparation is generally necessary. Avoid using any lotions or creams on the day of the examination. Temperature could affect the result of the test hence if the temperature is cold; the patient should wait in a warm room for a while before the test is conducted.
One concern with electromyographic testing is that needles are utilized and it could be painful. However, the new computerized technology permits the usage of needles that can records so that small insertion of it feels lesser painful than the insertion of a normal size needle. Needles with small gauge can be used, because nothing is aspirated or injected. A troublesome trend is the performance of nonphysician health care personnel in electromyographic testing. Interpretation of electromyograms and performance of electromyography needs enough technical skill and capability to assimilate physician’s understanding. [121] In a study conducted by Rathinaraj and colleagues regarding the efficacy of spinal segmental stabilization exercise program and the efficiency to improve the muscular activity and pain reduction which is assessed through electromyography because limited studies are conducted using electromyography as an assessment parameter of muscular activity. Their study showed that exercise play a vital role in alleviating low back pain particularly in the mechanical back pain brought by spinal instability, which needs spinal segmental stabilization exercise program. Positive progress in muscular activity and pain reduction proves the exercise program.
History of low back pain is associated with higher baseline muscle activation and that electromyography responses are modulated from this activated state, rather than showing acute burst activity from inactive state, perhaps to prevent trunk displacements.
Nerve conduction studies are essential part of the complete electrodiagnostic examination. [123] In a nerve conduction studies, the contraction is caused by the electrical charge distributed to the nerves in the periphery. An electrode capable of recording is posited on a muscle innervated by the specific nerve, and information about impulse can be recorded including its latency. Latency is the time required for an impulse to travel from stimulus to the recording. Nerve conduction velocity and the distanced traveled can also be computed. The said measures are important gauge of damage to the nerve which specifically tests the integrity of the myelin sheath of the nerves. The nerve conduction studies and needle examination are key components of a complete electromyographic examination. The amplitude of the contraction of the muscle can be compared signal’s initial size thus providing information regarding the number of functional neurons that consists the nerve.

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Nerve conduction study is also referred as nerve conduction velocity test. During this procedure, two electrodes will be attached to the surface of the skin. One electrode will stimulate the nerve while the other one will record it. The speed of nerve conduction studies is associated to the degree of myelination and diameter of the nerve. A nerve functioning normally transmits a stronger and faster impulse than an altered nerve. It is like an electric wire with plastic or rubber insulation around it. Generally the range of normal conduction velocity is 50 to 60 meters per second. However, the normal conduction velocity may be different from one nerve to another and one individual to another. Nerve conduction velocity test is commonly conducted along with electromyography. A condition that may be examined with nerve conduction studies includes Carpal tunnel syndrome, Guillain-Barre Syndrome, Charcot-Mari-Tooth syndrome, herniated disc, neuropathy, polyneuropathy, sciatic nerve problems and peripheral nerve injuries. Nerve conduction study techniques specifically include motor nerve conduction studies and sensory nerve conduction studies. Sensory nerve conduction studies are normal when focal sensory loss is due to nerve root damage for the nerve roots are proximal to the nerve bodies in the dorsal ganglia. [33]
Evoked potentials or evoked responses, measures the electrophysiologic responses of the nervous system to different stimuli. Theoretically, almost any sensory modality can be tested, however in clinical practice only few are used in routine basis. [208] Evoked potentials demonstrate abnormal sensory function when the neurologic test results do not reveal abnormalities. It reveals clinically unsuspected pathology when demyelinating disease is suspected. It determines the anatomic distribution of a disease process and it objectively monitors the condition whether the patient is progressing or not. [125]
Visual evoked potential examines the function of the visual pathway beginning from the retina going to the occipital cortex. It specifically measures the capacity of the visual pathways to conduct from the optic nerve, to theoptic chiasm and optic radiations going to the occipital cortex. Brainstem auditory evoked potentials measure the function of the auditory nerve and auditory pathways in the brainstem. [124] Somatosensory evoked potential is a diagnostic test to assess the speed of impulse conduction across the spinal cord. The said methodology is consists of using electrical stimulus in the nerves of arms and legs measuring the impulse generated by different points in the body.
Electrodiagnostics is utilized to examine lumbosacral radiculopathy potentially underlying low back pain. The examinations serve as an extension of the physical examination and clinical history furthermore it complements the neuroimaging studies. Among the common low back pathologies amenable to electrodiagnostic studies include spinal stenosis and lumbosacral disc herniation. The electrodiagnostics can help in the decision making processes when considering surgical management. [126] Electrodiagnostic studies are essential part of the diagnostic evaluation when the physical examination or history suggests that neural structures may contribute as symptom generators. Lumbosacral radiculopathies, peripheral nerve injuries and plexopathies are of primary concern when examining patients having low back pain. The study assists in quantifying neurophysiologic injuries and alterations using the said techniques.
Bone Scan
A bone scan shows the images of metabolic activity of the skeleton. Conventionally, it is accomplished by imaging radionuclide whose physiology closely resembles a metabolic activity within the bone. Nuclear scintigraphy of the bone generally uses the radionuclides fluoride-18 (F-18) or technetium-99m (Tc-99m). Tc-99m is commonly attached to medronic acid (Tc-99m MDP) and F-18 incorporated into sodium fluoride (F-18 NaF). The molecules are injected intravenously while a nuclear camera that contains salt crystal captures the decay of photons from radioisotope. This is attained through the process of fluorescence or scintillation that occurs when the photon released by the radionuclide hits the salt crystals within the nuclear camera. The scintillations are converted to images for interpretation by nuclear medicine specialist. [127] A bone scan is used utilized to: [143]

Diagnose a bone tumor or neoplasms
Ascertain if a cancer already metastasizes to the bones. The common cancers that could spread to the bones include breast, lung, prostate, thyroid, and kidney.
Diagnose a fracture, especially if it cannot be seen on a plain x-ray
Rule-out osteomyelitis or bone infection
Determine or diagnose the etiology of bone pain, when no other cause has been recognized
Assess metabolic disorders, such as renal osteodystrophy, osteoporosis, osteomalacia, primary hyperparathyroidism, complex regional pain syndrome, and Paget’s disease

Bone scans are useful in a wide range of conditions. A common reason to have a bone scan is for examination of pain, in which bone scan can assist in identifying whether the source of the pain if from bone pathology or form soft tissue trauma. There are no specific preparations needed for radionuclide bone scan when using the tracer that map calcium metabolism, F-18 NaF or Tc-99m MDP. Patient should continue take their medications normally and eat normally. It is helpful to stay hydrated since the radiotracers are eliminated through the urine. Bone scans were known to emit much more radiation than CT and radiography. It must be kept in mind when considering whether or not to perform scans on a child. [108]
Before the bone scan, the patient should make it known if she is or might be pregnant and if she is breast feeding. The patient can use formula for 1 to 2 days after the scanning to wait until the radioactive tracer is gone from the body. The patient should report to the doctor if he or she have had an X-ray test utilizing barium as a contrast material, such as a barium enema or have taken a medication that contains bismuth within the past 4 days because barium and bismuth can interfere with test results of the scanning. The patient should limit his or her fluids for up to 4 hours before commencing the the test for the patient will be instructed to drink extra fluids after the injection of the tracer. The patient will empty his or her bladder right before the scan. Most probably the patient will have to wait for at least 1 to 3 hours after the injection of the tracer before your bone scan is done. [144]
The images produced by the bone scan should depict that the radioactive material has been distributed evenly all over the body. There must be no areas of increased or decreased distribution. “Hot spots” are portions with an increased distribution of the radioactive material. On the other hand “cold spots” are areas that show lesser of the amount of radioactive material. [143]
Many false-positive results can be expected among older adults. Discitis, osteomyelitis, metastatic disease, rheumatoid arthritis, degenerative spondylosis and ankylosing spondylodis may result in abnormal findings in the spine that are not directly related to acute trauma. False-negative results may occur in the first hours after acute trauma. If possible, 72 hours should be allowed to pass prior to nuclear bone scanning of the lumbar spine is attempted. [127]
Thermography
Thermography is a noninvasive procedure that images infrared radiation (heat) released by the body surface. It is based on the principle that alterations in different of body functions alter the cutaneous vascular supply. Pain is a complicated phenomenon that cannot be simplified to a direct correlation with cutaneous heat production. Thermography. Thermography does not take a picture of pain itself; it does reveal pathophysiologic conditions related with soft tissue, circulatory neurovascular and musculoskeletal disorders.There are two type of thermography. It includes liquid crystal or contact and electroninc or noncontact thermography. [129]
The contact thermography utilizes cholesterol crystals that changes in color with the variations of surface temperature. The crystals are placed inside inflatable transparent boxes with one thermosensitive, flexible side that is applied to the body of the individual. Each of the boxes has a limited temperature range and its utilization for examination requires proper selection of the box with accompanying proper temperature range. An image is taken of the box to record the patterns of surface temperature. The box is chosen by trial and error method. The advantage of contact thermography includes the absence of radiation, much lower cost than electronic thermography and much easier to use. Electronic thermography uses an infrared radiation sensor that converts heat reading to electrical signals that are displayed on a black-and-white or colored monitor. A picture can be taken from the video screen. It can be also stored on a computer. This system has the advantage of viewing large areas of the body during a single examination. Examinations must be conducted in an air-conditioned, draft-free room. The ambient temperature must be between 68 degrees to 72 degrees Fahrenheit. The patient should also be instructed to refrain from cigarette smoking for the day of the test. Furthermore, the patient should refrain from taking pain medications, physical therapy and exposure to sunlight for at least 24 hours. The patient must be in equilibrium with room temperature for 30 to 60 minutes before the beginning of the procedure. The examination will be postponed if the patient is febrile. [129]
The examination of lumbosacral spine and lower legs with contact thermography consists of individual images of buttocks, posterior and lateral thighs, lower legs, dorsa of the feet, and toes. The examination requires 1 to 2 hours to complete. Abnomalities in the physiologic temperature distribution pattern also indicates alterations. Acute pain is said to be associated with increased heat whereas chronic pain is related to decreased temperature. Increased temperature is found over areas involved in an inflammatory process. Studies have stated a close correlation between abnormal thermograms and surgically proven discs. Investigators have also found that patients with disc herniation have a thermography and myelography accuracy rate of 95% and 84% correspondingly. [214] Thermographic findings correlated with magnetic resonance, myelography and computed tomography abnormalities in 94%, 80% and 84%. Twenty two magnetic resonance scan of patients with prolapsed of the disc associated with nerve root lesion, 95% of them had leg abnormalities on thermography. [129]
There is a good relationship between changes in symmetry of heat patterns and changes in pain intensity for most of the disorders that causes chronic pain. Thermography has been reported to useful in differentiating pain-free from pained subjects reporting back pain, knee pain, and leg pain. Thermography consistently indicates painful areas among patients with spinal cord injury.
Ultrasound Imaging
Ultrasound is a type of imaging which uses high-frequency sound waves to look at visceral organs and structures of the body. Ultrasound imaging of the musculoskeletal system is painless and safe. It is also called as ultrasound scanning or sonography. It involves the use of a probe or small transducer and ultrasound gel placed directly on the surface of the skin. The transducer transmits high-frequency sound waves through the gel into the body. Then, the transducer utilizes the sounds that bounce back and use them to create images in the computer. There is no risk for radiation because ultrasound imaging does not utilize ionizing radiation like what is used in radiography. Since sonographic images are captured in real-time, they can show the structure and the body’s internal organ movements, including the blood flow through the blood vessels. Ultrasound imaging is noninvasive medical test that aids physicians diagnose and treat medical disorders. Musculoskeletal ultrasound provides pictures of muscle, ligament, tendons, joints and soft tissue throughout the body. [142]
Ultrasound images are commonly used to help diagnose certain musculoskeletal conditions such as: tendon tears; muscle tears, masses or fluid collections; tears or sprain of ligaments; fluid effusion or inflammation; early alterations caused by rheumatoid arthritis; nerve entrapment; ganglionic cysts; benign and malignant soft tissue tumors; hernias; foreign bodies; and dislocations. [142]
Patients should be instructed to wear loose-fitting, comfortable clothing for the examination. The patient may be required to remove some of the clothing and accessories in the area to be examined. Ultrasound examinations are sensitive to motion. An active or crying child can lengthen the examination process. No other preparation is required. Musculoskeletal ultrasound evaluation is usually completed within 15 to 30 minutes but can take longer. Ultrasound may have difficulty penetrating the bone, hence only the outer surface can only be viewed. There are also limitations on the depth the sound waves can penetrate, thus deeper internal structures of larger patients may not be seen easily. [142]
 

Comparison of Social and Medical Models of Health

The ways in which health, illness and disease are defined depends on different factors and models, For instance the way the practitioner defines health is different from the way other people in the society defines it. There has always been diversity in the theoretical of health and illness in the western culture. Though the models of health may vary, these models play a defining role, signifying what should be or not be the object of public health concern. This essay will define and compare the medical and social model of health and also discuss their key components.
The social model of health places importance on the changes that needs to be made by society, empowering people to be in charge of their own health and lifestyles, in order to make the population healthier.
The medical model defines health as absence of disease, it informs the most powerful and influential discourse about health. The medical model is the most main system of medical knowledge within the western world, its activity is the treatment of disease in individuals. It’s the model that quite defines health narrowly.
Social model of health key components involves health being determined by a broad range of social, environmental and economic factors as not just biomedical risk factors, it also act to reduce inequalities that has to do with age, gender, race, culture, socioeconomic status and location because equity is the main point for health service delivery.
The key component of the medical model of health involves the standard analytical format process:
Underlying the model is the implicit assumption that the illness described by the person, now called patient, indicate a disordered part, or pathology, called the disease or disorder which is the cause of the illness.
The social model of health differences when compared to the medical model of health are as follows:-:- The social model of health is focus more on the environment, social, and environmental determinants of health, not just biomedical determinants. While, the medical model is centred on individual as a patient. The medical model has a core structure of analysis by which symptoms and physical signs known as illness are reduced to more specific disordered part while the social determinant of health is the social and environmental condition people work and live. Medical model deals with a specific disease with specific therapy while social model of health is based on the understanding that in order for health gains to be present we need to meet the people’s basic needs.
In addition to the comparison, the social model of health takes into recognition the environmental and social factors that affect health and produce inequities whereas the medical model serves well for illness caused primarily by organic diseases – albeit with serious limitation when no specific cause or cure is known.
In conclusion, Human kind is believed to be the only one that does not allow nature to be just nature. The most commonly accepted vision of healthcare is that improvements result from advancements in medical science.
It is widely accepted that the medical model of health focuses primarily on the eradication of illness through diagnosis and effective treatment. In comparison the social model of health emphasis on changes in the society and in people’s way of life to make the population healthier. Taking into consideration these models of health allows us to have a better knowledge of why some people take care of their health easily than others.
 

Medical Personal Statement Examples Personal Development Essay

From an early age I have been fascinated by the workings of life. The human body is a remarkable machine with many diverse systems producing an organism that could never be artificially reproduced. My love of science is just one of my reasons for choosing medicine. I enjoy a challenge particularly towards a rewarding objective and although medicine is a tough career it can be enormously gratifying, highlighted by the doctors I have spoken to during my experience and on a personal level.

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To further my insight into the medical field I participated in a work shadowing week at a GP surgery. I gained a valuable understanding of the workings of the surgery, with opportunities to observe and speak to the doctors regarding a medical career. I arranged another placement week myself at a local hospital, which was a superb opportunity to observe medicine from another point of view. I observed the ward rounds, an MRI scan, a skin biopsy and an endosocpy clinic all which I found interesting. I spent the most time with the haematology team, responsible for patients with diseases such as Chronic Myelogenous Leukaemia (CML), haematology being one of my interests it was captivating that I could see the specialty from a more complex side than the AS biology course. For example I was able to understand how the level of platelets affects blood clotting. Throughout the week I expanded my confidence and communication skills through speaking to patients and doctors. Although I enjoyed the week it was at times extremely heart-rending, I was able to get close to many of the terminally ill patients helping and caring for them where I could, getting them tea or just talking and empathising with them to build their spirits. I volunteered at a local home for the elderly which was very rewarding as I built my caring skills, helping residents by making them tea or playing cards with them. At school I took part in a paired reading scheme for 6 months where I was able to help young children to read, speaking and listening to them to help their English. All my experience has made me more determined to accomplish my ambition to be a doctor.
My love of science and aspiration for a medical career is reflected in my A-Level choices where good time management, self motivated study skills and ability to cope with stress and pressure are essential. Biology and chemistry have helped me further my interest and develop my analytical skills, maths helps my problem solving skills helping me to work logically and ICT gives me a valuable insight into the rapidly developing technological world where computers are crucial. I believe all the qualities I have developed through my courses are essential for any good doctor. I have participated in the Duke of Edinburgh award scheme which enabled me to achieve a first aid certificate including cardiopulmonary resuscitation training. I also enhanced my inter-personal, communication and team building abilities, valuable skills for any medical occupation, as I witnessed during my experience. For 2 years I have volunteered at a local vet hospital observing and helping out 2 hours per week communicating with the public in a different environment. I enjoy reading, mainly factual books to expand my general knowledge. To relax, I enjoy sports including football, and cricket for which I was captain of the school team and my local team for the past 3 years improving my leadership skills. I also recently rekindled my childhood passion for golf, another pastime I enjoy even if it is a little expensive!
I am a self motivated, determined individual and I look forward to the social and academic challenges of university. I am aware of the demands of a medical career but my commitment and desire to become a doctor has only been strengthened through my experience and work in a voluntary capacity.
No.2
To be given the opportunity to read medicine, will not only fulfil my ambitions, but also allow me to be a credit to the medical institution. I am a dedicated learner and I have the ability to listen diligently to people. I believe there is a severe lack of black female doctors and I will endeavour to be part of the improvement of this situation and be an asset to my community.
No.3
From a young age I have been genuinely fascinated by the intriguing world of Science. This passion has fuelled my love for medicine, particularly as I have always been amazed by the complex and intricate workings of the human body. The fact that medicine is an extremely challenging, demanding and rewarding profession leaves me with no doubt about wanting to become a doctor. My A-level studies have reinforced my decision to pursue this career path and allowed me to develop essential skills for this degree. Chemistry has enhanced my analytical and problem solving skills. My accuracy, attention to detail and natural ability to solve problems has been developed through studying Physics and Maths. Reliable observational skills and experimental technique has been developed through during practical work in Chemistry, Physics and Biology. Exiting visits to the Body worlds exhibition and conferences organised by med-link confirmed my desire to pursue a medical degree
No.4
My motivation to study medicine comes from the desire to combine my interests in the ever-expanding fields of medical science with my need to understand life from other human perspectives. This drive was reinforced by my visit to Christie Hospital where I saw how advances in medical diagnostics and treatment directly impact upon the lives of cancer patients. By becoming a doctor I hope to be able to work at the crux of science and society by pursuing a deeper understanding of complex biological systems, whilst at the same time using my knowledge to make a difference to the individual.
After reflecting upon all my experiences so far I believe that as a doctor I will possess the tenacity, humanity and dedication to excel in both academic and personal challenges.
No.5
My A-level subjects have given me a sound scientific knowledge base and have developed skills and qualities which are particularly relevant to my chosen degree. These include observational, investigative, analytical, reasoning and communication skills. My self-confidence, self-reliance, adaptability and willingness to assume responsibility have been enhanced not just through my studies but through extra-curricular activities and considerable work experience.
My desire to pursue a career in medicine has only intensified as a result of my work experience and voluntary sector commitments. The chance to study medicine is my long cherished ambition. I believe I have the skills and qualities necessary to succeed in the medical profession, and I welcome the academic rigour and opportunity to participate fully in all aspects of university life.
No.6
INTELLECTUAL ABILITY I love to be challenged about my ideas and opinions. I have relished the intellectual challenge offered by Chemistry and learnt how to develop arguments and clarity of expression in History. In particular, I have enjoyed exploring the history of medicine, which has enhanced my understanding of the ancient profession I would so love to be a part of
CONCLUSION I intend to make medicine my life’s work. I think medicine is the most fundamental of professions; without doctors society would surely collapse given that one’s health is a prerequisite to doing almost anything in life. I would be privileged to spend the rest of my working life practising medicine. I am acutely aware of the difficulties and challenges I am signing up for, but am confident that I will meet them with (enthusiasm) gusto and commitment.
INTRODUCTION – reasons for studying for medicine To be given the opportunity to study medicine would be a dream come true/the fulfilment of a life-long dream. The science of medicine fascinates and inspires me; reading StudentBMJ and NewScientist compel me into learning more. A central attraction of medicine is the chance to make a difference to another person’s life, and to be able/ (in a position) to offer informed support and understanding at a vulnerable time for a patient and their family. (For many) illness is very scary and access to a compassionate and committed/attentive/helpful/caring doctor can make a significant difference to a potentially traumatic experience. I am an open-minded, approachable person and I would aspire to making vulnerable patients feel at ease; I have the social skills conducive to being an effective doctor, not a scientist
No.7
Disease can take everything from us; potentially undermining our capacity to meet challenges, seek happiness or improve ourselves. Valuing all of these things within myself, one of the most frustrating things I have had to witness is people being unable to do the same. We cannot give people happiness, but effective healthcare can give people the chance to seek their own.
Of course, healthcare has many facets; but a longing to ask ‘why?’, and also to question the answer, has helped lead me toward medicine. Whilst at college, exploring the human body, more intricate than any man-made machine, has helped me feed this fascination. Case studies like cystic fibrosis made it especially relevant. In addition, books such as ‘The Chemistry of Life’ and ‘The Man Who Mistook His Wife For His Hat’ have helped me extend my passion past the scope of the curriculum, engaging with ideas independently.
Furthermore, AS Perspectives on Science has developed my ability and desire to interact with the medical world. The course culminated in an extended report in which I chose to discuss the scientific and ethical implications of HIV testing; questioning issues such as the extent to which patient autonomy should be endorsed. This has been enormously satisfying, and my drive to learn about medical cause, effect and treatment has only increased. Along with my Philosophy course, this has helped to shape the way I think about the world and given me the tools, and opportunity, to engage with other people and their ideas.
I have always had a need to help people. More recently, highlighted by volunteering at St. Michael’s Hospice, I have developed my devotion to caring. Assisting in providing palliative care has been a difficult but exceptionally rewarding experience. Each time I connected with a patient, I felt I had added something to his or her day, if only for a little while. To then find the following week that they had deteriorated was hard, but pushed me to persevere. Perhaps the most poignant lesson I have learned is that, however much we wish otherwise, there is a limit to what we can do for people; there will be times when I am faced with helplessness. Complementing this, partaking in a project evaluating sexual health services has given me the chance to help spur improvement. But more importantly, analysing healthcare from a patient perspective emphasised the fundamental need for integrity, effective communication and understanding. Hence, all of my volunteer work has helped me to develop, among others, my sensitivity and interpersonal skills.
Additionally, teaching myself piano and exploring its complexities, I have had many opportunities to develop my dedication and independence. While in a youth folk band, I was chosen to participate in a music exchange. I enjoyed immersing myself in new cultures and, travelling around France and Germany, worked with musicians far more skillful than myself. Furthermore, my love of martial arts has also given me chances to push my limits. The more I practice both of these, the more I realise how much more there is to learn. Being elected as head boy in secondary school I also worked to progress other skills including teamwork as well as public speaking.
I recognise medicine is a difficult route, but it is the challenge which makes it more rewarding. Not only does it enable me to take my passion beyond college to a setting where my knowledge must constantly evolve, but, perhaps more importantly, it allows me to put this into practice in a meaningful way. I hope that in doing so I can give others the same opportunities I have had myself#
No.8
I have always been interested in all aspects of the human body. I am therefore very excited by the prospect of studying Medicine and using the knowledge I would acquire to help people. In 2006 I attended a ‘Med-Six’ conference at Nottingham University and found the few days I was there utterly engaging. The lecture on Emergency Medicine emphasised the importance of an efficient team with a decisive leader, which I found particularly stimulating. We took part in a simulated accident and emergency team exercise and each played specific roles, for example nurse, radiographer and consultant. We had to assess individual patients and make rapid decisions about how the team should deal with them. It showed me how much Medicine relies on teamwork and communication.
I was very fortunate to be able to organise a week shadowing an orthopaedic surgeon. I accompanied him on his ward rounds in the morning and was then able to watch him performing hip arthroscopies. I was also present during consultations with new patients on clinic days. I observed how he empathised with the patients when he briefed them before their operations and during patient consultations when he informed the patients of the possible outcomes of the surgery. I saw that in the operating theatre every member of the team was integral to the success of the operation and that the team needed a strong leader. I also gained an understanding of the immense concentration and skill involved in this type of surgery. At present I am working as an Administration Assistant at a hospital; through dealing with patient records I have gained an appreciation of the importance of patient confidentiality. I will soon be applying for a post as a Nursing Assistant at a London hospital to gain more patient contact.
The study of Medicine offers a great deal and I believe I have the enthusiasm, perseverance and commitment necessary to make a good doctor.
No.9
In order to explore my fascination with medicine I have undertaken varied and relevant work experience, in both a hospital and a care home. Whilst working at the Royal Blackburn Hospital, I had the opportunity to shadow current medical students, where I learn’t various procedures such as catheter and cannula insertion, in addition to playing an active role in practical demonstrations using SimMan. Shadowing junior doctors on the Gastroenterology Ward allowed me to begin to understand the structure of a hospital. I was able to appreciate the high level of teamwork required between the consultant and other healthcare professionals. This ensured the treatment given to patients was both efficient and effective. I was privileged to have the opportunity to interact on a one to one basis with patients, which enabled me to tailor my communication skills to suit the patient and their situation. My time in hospital concluded with a presentation, which I presented to the junior doctors and a consultant regarding my experience, which further enhanced my communication skills. I gained great admiration for the consultant, who was able to instill belief and reassurance within his patients, even in the most extreme circumstances. Equally, my time spent at Viewfield Care Home allowed me to converse with patients on a regular basis, whilst developing my nursing skills. Both these experiences gave me an extensive insight into the fundamental characteristics which a doctor must possess, namely being caring, competent and approachable at all times, all of which I believe are key qualities of my personality. Reflecting upon these experiences has reinforced my desire to pursue a career in medicine, for which I now have resolute determination.
I believe I possess a suitable personality to undertake the demands of being a medical student and doctor, as I thrive in challenging situations, both mental and physical, while at all times remaining competent and demonstrating both empathy and integrity.
No.10
This incident sparked my initial interest in Medicine. To further explore the world of Medicine, I began to read popular medical articles in the newspapers and became a frequent visitor to the BBC Health page. I also read medical related articles in the New Scientist. In order to experience the practical aspects of the life of a doctor, I completed work experience under an Oncologist for two weeks and also at my local GP clinic for a month. Here I was most impressed by the doctor’s ‘bedside manner’. I witnessed the calm and reassuring tone of the doctor, who often used humour as well, to put the patients at ease so as to elicit information he needed to come to a sound diagnosis. I next undertook community service at a residential home for the elderly for a few months and over time I was amazed at the tact and patience of the staff who allowed the residents to keep hold of as much of their independence as possible.
My interest in Science and Mathematics is reflected in my A-level choices. I believe that the scientific method is the most reliable way for man to augment his knowledge of the world around him. I love Mathematics, which has taught me to be logical in my thinking and precise in my actions. I am hard working and know I have the intellectual abilities to study Medicine. I realise a good doctor also needs to be able to communicate effectively; I have an open and friendly personality, finding it easy to make relationships with my peers as well as my teachers. Additionally I have the qualities of care, compassion and commitment, which I believe make me an ideal candidate to study Medicine and serve as a Doctor.
No.11
I am a keen table tennis player and play regularly at a local club as well as with my friends and family. I organise a table tennis club for the sixth form as well as an after school club where I offer coaching to beginners. This has not only been of huge enjoyment but has also helped me develop my organisational and leadership skills. I also captained the football and
hockey teams at Hebron for two years.
Essentially, I feel I have gained a realistic appreciation of the challenges, both emotional and physical, involved in pursuing a career in medicine, but believe that my experiences have given me the motivation and commitment to withstand such trials and enable me to succeed as a valuable member of the developing medical field.
For me, a career in medicine is the perfect opportunity to stimulate my mind in a fascinating field in which I am highly motivated to succeed. I eagerly anticipate the opportunity to be able to combine my caring personality with the practical aspects of the subject, and so have a major impact on people’s lives. The prospect of life-long learning in a subject for which I have such an affinity excites me.
I thoroughly enjoy studying A-level Biology and Chemistry and my intellectual curiosity ensures I stay well ahead of the syllabus. For example, I was recently intrigued by an article on developments in cancer treatment, discussing how antibodies can be engineered to bind to specific antigens on the surface of cancer cells, allowing attached drugs to be delivered directly to tumours, and was inspired to do further research.
 

Using animals in medical research

Introduction
     Throughout history, animals (refers to ‘non-human animals’, excluding human) are widely used in different fields. However, the issue of using animals in medical research notably attract public attention because, to many people, it appears unnatural and cruel, even though the number of animals used for other purposes and the ill-effects exposed (eg. blood sport) may often be greater, because the estimated 50 million animals used annually in experiments worldwide only account for about 0.2% of all animals used (Mepham, 2008).

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     The debate about animal experimentation ranges broadly over two distinct questions. Firstly, do animal research yields useful knowledge that could not be gained from other source and secondly, is it morally acceptable to use animals in a way that cause them harm (Nuffield Councils on Bioethics, 2005). The question of scientific justification is, obviously, fundamental to the question of moral justification.
Scientific Justification
Justified
‘There could have been no oral polio vaccine without the use of innumerable animals. Without animal research, polio would still be claiming thousands of lives each year.’ (Sabin, 1995)
The primary reason given for using animals in research is that most medical advances since the 19th century have resulted from research using animals (Mepham, 2008). Among the examples are the extraction of first hormone (1902), a chemical treatment for syphilis (1909), isolation of insulin (1920), modern anaesthetics (1920s), kidney transplants (1940s), chemotherapy for leukaemia (1960s), and meningitis vaccine (1980s) (Monamy, 2009; Mepham, 2008). According to Sabin (1995), those who view animal experimentation as useless overlook the fact that it has been instrumental in developing medicines that saved countless human lives, such as the development of polio vaccine in 1957.
Next, halting animal research would have unfavourable consequences for human health and welfare since there are no viable alternatives to animal experimentation yet (Mepham, 2008). Paris (1994), too, expressed that ‘all of the work being put into improving health care system will be for nought if we allow a powerful band of self-righteous activists to deny us the privilege of studying non-human animals – medical science’s most valuable tool in the fight against disease.’
Lastly, animal experimentation is justified due to the extensive biological similarities between the physiology of humans and non-human animals (Mepham, 2008). This is supported by Bernard (1865), who stated that ‘the vital units, being of like nature in all living beings, are subjected to the same organic laws…’ Even if the knowledge itself cannot be directly applied to humans, they add to the level of understanding that may eventually be exploited in human medicine (LaFollette & Shanks, 1996).
In short, animal experimentation is essential to ensure scientific progresses. We live in a modern age where life-threatening diseases are kept at bay to an extraordinary degree, bringing about the majority of us to forget that as recently as 60 years ago, many diseases (eg. TB, polio) were common killers in our society (Monamy, 2009).
Unjustified
However, there are also people who believe that animal experimentation is scientifically unjustified. For example, Burgos (1996) brought forward the argument that ‘it is impossible to cure a sick human by experimenting on animals, just like how it is not possible to cure a sick cat by experimenting on humans. Every species have different biomechanical and biochemical entity, and it is difficult to extrapolate data from one species to another. Moreover, every species reacts differently to different substances. For instances, aspirin kills cats and penicillin kills guinea pigs. Yet, the same guinea pig can safely eat strychnine- one of the deadliest poisons for human, but not for monkeys. Sheep can swallow enormous amount quantities of arsenic. Potassium cyanide, deadly for humans, is harmless for owl.’
Supposing that one has chosen the best model for a human disease, it is still difficult to decide the dosage of the drug for humans. The thalidomide tragedy is one of the many examples of how things can go wrong. The sedative drug thalidomide was introduced in 1956 and widely used by pregnant women to reduce nausea and vomiting. But by 1960s, it was identified as the cause of phocomelia- a devastating birth defect in which the limbs do not form properly and long bones in the arms or legs are absence (Mepham, 2008).
Another example that shows the limitations of animal studies in assessing human reactions to drugs was dramatically illustrated by the detrimental effects experienced by the six male volunteers to the oral administration of TGN1412, a drug developed to treat rheumatism (Mepham, 2008). Although the drug had been tested on animals without deleterious effect, it produced life-threatening reaction on humans.
Ethical Justification
Cartesian
Today, few will argue that animals are like machines and have no souls, hence granting us the rights to use animals in any ways that we see suited. However, back at the 17th century, this human-centred view was very prevalent. Rene Descartes (1596-1650), especially, played an important role in the early debate. Descartes (1637) believed that ‘the divine gift of soul distinguished the human from all others’ and the reactions of animals were dismissed as mere reflex. This, as a result, provided a convenient ideology for early vivisectionists (Monamy, 2009).
Descartes’ statement was, also, supported by British psychologist Nicholas Humphrey. ‘…Descartes was as nearly right as makes no matter. If we walk down on English country lane, we walk by ourselves. Trees, birds, bees, the rabbit darting down its hole, the cow heavy with milk are all as without insight into their condition as the dummies on show at Madame Tussaud’s.’ (Humphrey, 1983)
Such views are not widely held anymore, partly due to the fact that studies of self-recognition using chimpanzees and mirrors have shown that some animals are capable of recognising themselves and have self-consciousness (Monamy, 2009).
Kantian
     Immanuel Kant echoed the voice of ancients: non-human animals are non-rational, and hence demonstrably inferior to humans. However, he added a philosophical twist that helps ground one very common argument used to morally justify our treatment of animals (LaFollette & Shanks, 1996).He believed that as far as animals are concerned, we have no direct duties. Animals have no self-conscious and are there as means to an end. Our duties towards animals are merely indirect duties towards humanity (Kant, 1963; Monamy, 2009). ‘Animal nature has analogies to human nature, and by doing our duties to animals in respect of manifestation of human nature, we are directly do our duty towards humanity.’ However, he argued that overt cruelty to animals was to be avoided because how we threat animals does affect how we threat humans. ‘…he who is cruel to animals becomes hard also in his dealings with men.’
     Within Kant we, therefore, identify two elements of current moral thought about animals: the belief that humans are superior to animals because of our intelligence, and that we have some duties towards animals. These uphold the belief that although we should not be cruel to animals, we can use them for our purposes (LaFollette & Shanks, 1996).
     The problem with Kantian theory is its failure to make a theoretical distinction between animal species beyond human sphere. This theory can morally justify the use of a chimpanzee in an experiment where a mouse would suffice, because neither species has moral autonomy (Monamy, 2009).
Animal Welfare/Interest
‘The day may come when the rest of the animal creation may acquire those rights which never could have been withholden from them but by the hand of tyranny…… The question is not, can they reason? Nor can they talk? But, can they suffer?’ (Jeremy Bentham, 1789)
The first person to bring up the idea of equality was Bentham. He pointed out that the capacity to suffer should be a vital characteristic that gives a being the right to equal consideration. This was further upheld by Peter Singer’s Animal Liberation. Singer, reviving Bentham’s utilitarianism, argued for the liberation of animals based on equality of consideration and their capacity to suffer (Monamy, 2009). ‘The capacity for suffering and enjoying things is a prerequisite for having interest at all. Hence, it would be nonsense to say that it was not in the interest of a stone to be kicked along the road. A stone does not have interest because it cannot suffer. Nothing that we can do to it could possibly make any difference to its welfare. A mouse, on the other hand, does have an interest in not being harm, because it will suffer if it is.’
Moral judgements must be made based on equal interest and, we should never be influenced by species, in the same way as we should never be influenced by race or sex (Monamy, 2009). ‘If an animal suffered, there can be no moral justification for refusing to take suffering into consideration. No matter what the nature of the being, the principle of equality requires that its suffering be counted equally with the like suffering- in so far as rough comparisons can be made- of any being.’ (Singer, 1974)
Singer argued that since laboratory animals were capable of feeling pain, their interest must be considered morally by humans. If the level of suffering in an experiment is not outweighed by any increase in the quality of human life, it is morally indefensible to allow such an experiment to continue (Dolan, 1999; Monamy, 2009).
The idea put forward by Singer have provided a sensible starting point for debate over the moral issues essential in any discussion of animal experimentation. Virtually everyone, now, acknowledges that many animals, certainly mammals, feel pain- even though there is still disagreement about the severity or nature of the pain. Plus, majority too agrees that we cannot do whatever we want to the animals, at least if it causes the animals pain (LaFollette & Shanks, 1996; Monamy, 2009).
However, there are still some weaknesses concerning Singer’s argument. Firstly, moral calculations become impractical when all factors are taken into consideration. How do you quantify an amount of pain and pleasure? Or the benefits of an experiment to mankind? Secondly, Regan (1986) argued that utilitarianism has ‘no room for the equal rights of different individuals because it has no room for their equal inherent value or worth. What has value is the satisfaction of an individual’s interest, not the individual itself.’ Regan believed that this theory can easily be exploited since an evil means can be justified as long as there is a good end. Lastly, some suggested that it simply do not go far enough- there is more to life than pleasure and pain (Monamy, 2009). Charles Birch (1993) posed an interesting question: ‘If all animals used for human purposes were to be constantly anaesthetised for all their lives, thereby eliminating the pain/pleasure argument, would such a procedure be morally defensible?’
Animal Rights
     Animal rights moral view was brought forwarded by Tom Regan (1986). According to him, basic moral rights should be assigned to all beings who are ‘subjects of life’, due to the fact that ‘these animals have a life of their own, of importance to them apart from their utility to us. They have a biography, not just a biology. They are not only in the world, they have experience of it. They are somebody, not something.’
Regan claimed that all creatures should be treated equally unless there is some relevant reason that justifies otherwise. It thereby rules out discrimination based on irrelevant reasons. He proposed that every individual of any species should be considered to have an ‘intrinsic value’ (or ‘inherent value’), the value of conscious individuals, disregarding of their usefulness to others and independent of their ‘goodness’. Equal rights for such individuals protect their ‘inherent value’ and give them moral status (Mepham, 2008; Monamy, 2009).
When it comes to animal experimentation, Regan’s view is unequivocal: ‘…the rights-based view is categorically abolitionist…this is just as true when animals are used in trivial, duplicative, unnecessary or unwise research as it is when they are used in studies that hold out real promise of human benefits…the best we can do is – not to use them.’
     Nonetheless, some claims that ‘rights’ can be attributed only to individuals who can claim them, and that they can only apply in circumstances where that individual understands the notions of ‘rights’. However, Regan has countered this by pointing out that such a viewpoint would also withhold rights form infants, the mentally retarded and senile. Apart from that, many find the concept of animal rights confusing. Exactly what rights do animals have? Do every single animal, including insects, has the same right, or just mammals? (Mepham, 2008; Monamy, 2009; Dolan, 1999)
Reverence for Life
     Albert Schweitzer (1875-1965) believed that an ethic that advocated goodness towards all life and, not just to humanity, would be derived from emotion, not from rational thought. This belief contributed to his theory of ‘reverence for life’.
‘The most immediate fact of man’s consciousness is the assertion: I am life which wills to live in the midst of life which wills to life…he feels a compulsion to give every will-to-live the same reverence for life that he gives to his own….He accepts as being good: to preserve life, to promote life, to raise to its highest value of life which is capable of development.'(Schweitzer, 1936)
It is an ideology which makes no distinction between ‘higher’ and ‘lower’ life forms, plants and animals, human and non-human. Acceptance of the ethic does not mean that it is wrong to cause death of another creature, it is the causing of pain or death when it can be avoided that is wrong. Anyone guided by this belief will only cause death or suffering of any animal in cases of inescapable necessity, never from thoughtlessness (Monamy, 2009).
     ‘Those who experiment with operations or the use of drug upon animals….must never quiet misgivings they feel with the general reflection that their cruel proceedings aim at a valuable result. They must first have considered in each individual case whether there is a real necessity to force upon any animal this is sacrifice for the sake of mankind. And they must take the most anxious care to mitigate as much as possible the pain inflicted.’ (Schweitzer, 1936)
     In short, Schweitzer urged that all life must be given the same respect: the need for every experiment must be carefully reasoned based on the ideal of reverence for life, not sentience – an argument that gives a place to emotion (Monamy, 2009).
Conclusion
     ‘…there are no simple answers to be found and there is no single guiding principle that will answer the questions that are raised about the problems of animal welfare and the use of animals in our society….where ethical principles are concerned, there is no possibility of proving the validity of an ethical principle…’ (Stone, 1989)
In conclusion, the debate on animal experimentation is extremely complicated and it involves both rational discussion and personal feelings. Every one of us must, therefore, attempt to form an opinion of our own about the extent to which we use research animals.  

Literature Review: Medical Research on Schizophrenia

Research is a way of developing a better understanding of a specific chosen area which can help improve further studies within the chosen subject. An interesting subject to research is a mental health condition known as schizophrenia and how it affects people within modern society. This specific mental health topic was chosen due to personal reasons and also as a professional interest. This research paper will help gather more information and knowledge toward the understanding of the illness to help progress further within the mental health care industry.

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In an article published by Medical News Today (2014) Nordqvist (2014) it describes schizophrenia as a mental health disorder which affects the brain and causes delusions, confusions, social withdrawal, psychosis, loss of personality and can also cause the patient to portray some unusually bizarre behaviour. MNT (2014) also states that this disease of the brain will normally hit a person during their late adolescent years or early adulthood years, but goes on to stress that it can affect anyone at any given time of their life. According to research gathered by the National Institute of Mental Health (2014) a person suffering with schizophrenia will have to cope with the symptoms for life but, treatment can relieve many of these symptoms. The research information that was published by NIMH (2014) was secondary data founded and collected by medical professionals that study and research schizophrenia as a profession. The study that was conducted is known as an epidemiology study (a study of patterns of disease within the community or population) and was used to collect the primary data through participant observation and surveys (patient 2014).
In recent research studies it is suggested that one in three people to every 100 in the UK suffer with schizophrenia according to statistics provided by Mind (2014). This works out around 220,000 people living in Wales and England and around 24,000,000 worldwide suffer with this illness (RC Psych 2012). These figures founded for this particular research paper are qualitative (open questionnaires) and quantitative (numerical information collected through closed questions) based as they were done through doing surveys and questionnaires on the population of the UK society having home treatment and therapies to help deal with their mental health condition. They are also only based on people living at home with the condition so it excludes people who are confined to prison or within a mental health hospital so as one could imagine the statistics will be much larger in numbers than this. All these statistics come from reliable sources as the figures come from the amount of patients that are being treated by medical professionals, and they are then reported back to the government so that they are able to collect this information and record the figures accurately through the quantitative data gathered by the researches.
In 2009 Gattaz (2009) did a study examining the link between schizophrenia and the sufferer’s urbanicity. This study was carried out during 20 different studies (known as a systematic review, where more than one case is studied, Saha et al 2005) in Western Europe and at the end of it Gattaz (2009) came to the conclusion that the longer a person living in that kind of environment is exposed to urban residence the higher their risk of developing schizophrenia was. This study was ethical in its research as the subjects were all demographically similar with their age, gender, sex and migrant status being within the same range. However during this investigation one of the major methodological (which is the way the researcher would go about discovering the knowledge in a systematic way) (Killam, 2013) implications of conducting the study into the relationship between the neighbourhood and schizophrenia was the timing of the individuals exposure. This was discovered when March et al (2008) assessed and reviewed the study and looked into the validity and the reliability of the study (the quality and the accuracy of the results). This study then becomes unreliable and inconclusive due to the unethical approach which means the hypothesis to this research can be researched again through a more in-depth approach.
Kelly et al (2009) conducted research in order to find if there is a link between schizophrenia and urbanity. This was a longitude study spanning over several years. The subjects were identified by attending psychiatric services within an urban catchment of Dublin during the period of 1995 – 1998 where subjects from North East Ireland were also identified. The population used was 171 during the period of 1995 – 1998 and 153 subjects during the period of 1995 – 2001. All cases bar one were ethically Irish and all were male. The researchers collected qualitative data by means of face to face interviews.
The research found that males were almost twice as likely to suffer from schizophrenia in urban areas, in comparison to males in rural areas. However, incidences of psychosis were lower in urban areas in comparison to the rural counterparts. This research found that the results suggested that males were 48% more like to suffer from schizophrenia
This research did highlight the risks of schizophrenia when living in urban areas. However, this study gives a biased conclusion as all subjects were male and Irish. This research could not be used to generalise the risk cross culturally. Research involving an even ratio of male and female, also an even ratio of ethnicity would probably give a less biased result.
One website named as Schizophrenia (2010) Dr Ira Glick breaks down the etiologic pathway to explain the way that schizophrenia sets in. Etiologic is a medical research term, it is important as the collected information gathers evidence for the investigation into the causes of such illnesses and diseases (Miettinen 2011). The research described on the website schizophrenia (2010) goes on to suggest that schizophrenia starts with the early environmental insults which is the genetic predisposition where, this will then lead onto the neurodevelopmental abnormalities and target features. The later environmental insults start with the further brain dysfunction and schizophrenia which will then lead to the onset of psychosis which is the neurodegeneration and schizophrenia. The study shows that ever growing research suggests that schizophrenia could possibly be prevented whilst the mother is pregnant with their child or, in the early stages of childhood. This could be a good thing because as many other research studies suggest, schizophrenia runs in the family and that deformed genes are passed down hereditary through the family (NHS 2012).
RC Psych (2014) online research website has recently been looking into research suggesting that schizophrenia is linked with the misuse of the illegal drug known as cannabis. These studies suggested that there is a clear strong link between the two with the early use of cannabis and the later mental health issues in those with a genetic vulnerability. Not only was it found that schizophrenia is linked with cannabis misuse but also another mental health issue known as bipolar disorder. According to RC Psych (2014) there is now sufficient evidence that the younger the person is misusing cannabis the higher the chances are of developing the condition later on in life. So in other words they are stating that the more cannabis smoked by an individual the more susceptible the individual is in developing the illness.
Another research that has been studied between people who suffer with schizophrenia and healthy individuals asks the question ‘Is there a difference between the perception of emotional and non-emotional facial expression affected the same within healthy individuals and those who suffer with the mental health illness?’ The results from this study showed that patients suffering with schizophrenia showed impairments in the recognition of identity compared to the groups of young and old healthy individuals. Similarly though it found that old healthy individuals have the impairment of learning new faces the same as experienced in the ability of patients with schizophrenia recognising the learning of new faces (Silver 2014). The method used in this research was through direct observation where the participant’s behaviour was observed by the person conducting the research.
In one of the largest studies to ever be undertaken, scientists believe they are closer than ever before in understanding the complex interplay between a person’s upbringing and their genes that can result in schizophrenia (independent 2014). Within this study the group of Psychiatrists analysed the DNA of 37,000 schizophrenic patients with completely different backgrounds and found that 128 independent genes located at 108 different locations in the human chromosomes significantly contribute the susceptibility of developing schizophrenia, whereas before 83 of these have never been previously linked to the condition. This research study will hopefully prove to be a breakthrough in understanding and hopefully finding a cure one day for the illness.
Larsson et al (2012) conducted research into the use of counselling for individuals suffering from schizophrenia. The research methodology was analysing how eight psychologists talk about and around the topic of schizophrenia to patients by using semi structured interviews. This allowed the researchers to gather qualitative data. Each participant signed a consent form to and were fully briefed in regards to what date was being collected for research. This ensured that all research methods were completed ethically.
Larsson et al (2012) concluded that the use of psychology in diagnosing schizophrenia is heavily underrated, The diagnosis of schizophrenia is almost unheard of in counselling psychology literature. Researchers stated that “conflicting, theories about the cause and nature of schizophrenia have arisen as outlined by Geekie and Read (2009). These include evolutionary theories, psychodynamic and psychoanalytical, life event theories, sociological and anthropological and philosophical and existential theories.”
The research concluded that counselling along with medication brought something different to the treatment of schizophrenia. However, there was a danger of counselling pathologising the individual further. Counselling has been identified as being underepresented in the treatment of schizophrenia. Counselling was identified as being underrepresented within the NHS in general.
Further research using counselling and medication for individuals with schizophrenia could prove to be very informative in treating an individual. However, with NHS budgets getting cut, this could prove to be a barrier in effectively treating individuals with schizophrenia.
In the conclusion to the researches named above the most important thing is finding the key main factor that causes the illness to help in finding a treatment to try and prevent it, keep it at bay or possibly cure it. As research is put into place to help improve a better quality of life for persons suffering with conditions such as schizophrenia all the individuals taking part need to be treated equally therefore these studies need to be ethical in their research to help get a better understanding. Correct training of staff in hospitals, institutes, and self help groups would be of a beneficial factor but these are not cost effective and will cause the government to be paying out expenses for all aspects of the path that needs to be taken in getting there. On the other hand if a better understanding and knowledge of the condition was available to the sufferers then this could keep the cost down as the patients may not be afraid to seek help which can result in them leading a normal and healthy life the same as the next person, being able to get an education behind them, work, get a social life without feeling out casted due to the ignorance of mental health within society (Kings College London 2009).
There are so many different theories in the causes and implications on schizophrenia there will be researches going on for a very long time in trying to establish the true cause of the condition. From the research gathered above if society and medical professionals were more educated on mental health illnesses such as schizophrenia then there wouldn’t be as many problems and research into the condition would become easier as sufferers won’t feel as though they are being judged because of the condition but will feel more that there is help out there for them.
References:
Cannabis and Mental health (2014) Available online at: http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/alcoholanddrugs/cannabisandmentalhealth.aspx Accessed on 24/11/2014
Causes of schizophrenia (2012) Available online at: http://www.nhs.uk/Conditions/Schizophrenia/Pages/Causes.aspx Accessed on 25/11/2014
Crawford et al (2012) Report of the National Audit of Schizophrenia (NAS), RCP: London
DNA hope on schizophrenia: Research breakthrough points at over 100 genes (20143) http://www.independent.co.uk/life-style/health-and-families/health-news/dna-hope-on-schizophrenia-research-breakthrough-points-at-over-100-genes-9619638.html Accessed on 27/11/2014
Epidemiology (2014) Available online at: http://www.patient.co.uk/doctor/schizophrenia-pro Accessed on 27/11/2014
Kelly, B. O’Callaghan, E. Waddington, J. Feeney, L. Browne, S. Scully, P. and Clarke, M. et al (2010) Schizophrenia and the City: A Review of Literature and Prospective Study of Psychosis and Urbanicity in Ireland: Schizophrenia Research 116(1), pp. 75-89.
Killam, L (2013) Research Terminology simplified: Paradigms, Axiology, Ontology, Epistemology and Methodology, Sudbury: Author
Kings College London (2009) Excellence in Mental Health Care: Putting Evidence into Practice, Achievement of Excellence, London: Kings Health Partners, pp. 1
Larsson, P. Loewenthal, D and Brooks, O. (2012) Counselling psychology and schizophrenia: A critical discursive account. Counselling Psychology Quarterly 25(1), pp. 31-47.
Meittinen, O.S (2011) Epidemiological Research: Terms and Concepts, London: Springer
Mental Health Problems (2014) Available online at: http://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems Accessed on 26/11/2014
Nordqvist, C (2014) What is schizophrenia. Available online at: http://www.medicalnewstoday.com/articles/36942.php Accessed on 27/11/2014
Saha, S (2005) Systematic Review of the Prevalence of Schizophrenia. Available online at: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020141 Accessed on 25/11/2014
Silver, H. Bilker, W (2014) Social Cognition in Schizophrenia and Healthy Aging: Differences and Similarities
The path to Schizophrenia (2010) Available online at: http://schizophrenia.com/hypo.php Accessed on 25/11/2014
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