10 Questions testing critical thinking (includes ethics)

10.1 In what ways can doctors promote good health other than through the direct treatment of an illness?

Doctors promote health in loads of ways beyond just treating illness. During my paediatric placement, I saw this firsthand - doctors were constantly educating families about healthy eating, exercise, and managing chronic conditions like asthma.

They also focus on prevention through things like immunisation programmes and screening - I observed allergy testing that prevented serious reactions, and saw how early intervention with constipation management stopped bigger problems developing.

But it goes beyond individual consultations too. Doctors can set examples through their own lifestyle choices, run support groups, and connect patients with dieticians or other specialists. I think the best health promotion happens when doctors build trust and really listen to patients - like when that mum worked out her baby's lactose intolerance through trial and error, and the doctor validated her observations rather than dismissing them. Prevention and education are just as important as treatment

10.2 How does politics influence healthcare decisions?

Politics hugely influences healthcare through funding decisions. The NHS is taxpayer-funded, so governments have to balance providing quality care with keeping taxes at levels people will accept - it's always a trade-off.

This directly leads to rationing, where difficult choices get made about what treatments are available. During my paediatric placement, I saw how some families struggled to access certain specialists or had long waiting times, which reflects these resource allocation decisions.

Politicians decide which services get priority funding - whether that's cancer screening programmes, mental health services, or paediatric care. These aren't just clinical decisions, they're political ones about how to use limited resources. NICE guidelines are a good example - they assess whether treatments are cost-effective, not just whether they work, because the money has to come from somewhere. It's a constant balancing act between what's medically ideal and what's financially possible

10.3 Do you think it is right to allow private healthcare to run alongside the NHS?

"I think there are valid arguments on both sides. Private healthcare does take pressure off NHS waiting lists, and those patients are essentially paying twice - through National Insurance and privately - so that money can go to other NHS patients. There's also the personal liberty angle - should people be prevented from spending their own money on healthcare?

On the flip side, there's a fairness issue. A two-tier system means wealthier people get faster access to care, which feels at odds with the NHS principle of care based on need, not ability to pay. There's also the concern that private work might draw doctors away from NHS commitments.

Personally, I think private healthcare can coexist with the NHS as long as it doesn't undermine NHS services. During my placement, I saw how stretched resources were, so anything that eases pressure helps. But we need to ensure NHS doctors remain committed to their NHS work and that the quality gap doesn't widen too much."

10.4 How should healthcare be funded?

There's no perfect answer to this - every country struggles with it. The NHS model, funded through taxation, means healthcare is free at the point of use, which is brilliant for equity. Everyone gets care based on need, not wealth. But it does mean limited budgets and sometimes long waiting times.

In contrast, the US relies heavily on private insurance, which can offer faster access but leaves vulnerable people without coverage. France has an interesting middle ground - they have a public system but patients top up with private insurance for extras.

I think the NHS principle of universal healthcare is something worth protecting, but we need to be realistic about funding. Whether that's through higher taxes, some form of co-payment for certain services, or encouraging private healthcare to run alongside it - there's no easy answer. What matters is that everyone has access to essential care regardless of their income, while the system remains financially sustainable."

10.5 What do you think of the way doctors are perceived in the media?

"I think the media portrayal of doctors is quite mixed. On one hand, you've got TV shows that glorify doctors as heroic figures performing miracles, and positive stories about pioneering surgeries or doctors responding to emergencies. On the other hand, scandals like Shipman or Mid-Staffordshire get huge coverage, which can damage public trust.

The reality is the media needs to sell stories, so they focus on extremes - either the exceptional or the shocking. Most doctors are just doing their jobs day-to-day with care and competence, but that doesn't make headlines.

I do think the media plays an important role though. Exposing failures like at Bristol or Mid-Staffordshire forced the system to improve and held doctors accountable. That scrutiny is healthy - it keeps standards high and ensures transparency.

The challenge is balancing that accountability with fair representation. Most doctors are dedicated professionals, but a few high-profile cases can unfairly shape public perception of the whole profession.

10.6 What does the phrase "inequalities in healthcare" mean to you?

Inequalities in healthcare mean that people aren't getting the same access to care or health outcomes based on factors that shouldn't matter - like where they live, their income, or their background.

During my care home placement, I saw how socioeconomic factors affected health. Some residents hadn't accessed preventative care earlier in life because they didn't understand what was available or couldn't navigate the system. Education plays a huge role - health promotion messages about smoking, diet, or screening programmes don't always reach vulnerable groups.

There's also the postcode lottery issue. Someone in one area might get access to a treatment that's denied to someone in another area because different trusts have different budgets and priorities. That feels fundamentally unfair.

Language barriers and cultural differences create inequalities too. At my paediatric placement, I saw a mum who needed her son to translate over the phone - imagine trying to discuss your child's health through a language barrier. These inequalities matter because everyone deserves equal access to care.

10.7 What are the arguments for and against people paying for their own healthcare?

There are arguments on both sides. Paying directly for healthcare could reduce time-wasting appointments and encourage healthier lifestyles since people would think twice before seeking care. It might also create competition between doctors, potentially improving standards.

However, I think the downsides outweigh the benefits. The poorest people, who often need healthcare most, would struggle to afford it. During my care home placement, I saw residents who'd delayed seeking help earlier in life due to cost concerns - that delay made conditions worse and more expensive to treat later.

There's also a risk people would choose cheaper treatments over better ones, or avoid seeing doctors altogether until conditions become serious. Chronic illness costs would spiral, and it could create a money-based doctor-patient relationship that undermines trust and medical judgment.

Overall, while our current system isn't perfect, having healthcare free at the point of use based on need rather than ability to pay feels more equitable and prevents worse outcomes down the line

10.8 What are alternative medicines/complementary therapies?

10.9 What is your opinion of them?

10.10 Do you think the NHS should provide alternative therapies?

Alternative and complementary therapies are treatments that differ from conventional medicine. Alternative means using them instead of conventional treatment, while complementary means using them alongside it - that distinction matters.

I think there are some benefits. They often involve longer consultations and more patient contact, which can be therapeutic in itself. For patients where conventional options have run out, they offer hope. And some, like acupuncture for pain management, do have growing evidence bases.

However, I have concerns. Most lack the rigorous evidence base that conventional medicine requires. The mechanisms aren't well understood, regulation is patchy, and some practitioners aren't medically trained, which means patients might make poorly informed decisions. Some treatments can even be harmful or interact with conventional medicines.

I think there's room for certain complementary therapies within healthcare, but only with proper research, regulation, and oversight. They shouldn't replace evidence-based treatment, but might support it in specific cases where there's genuine evidence of benefit

10.11 Should the NHS deal with patients who have self-inflicted diseases?

I I think the NHS absolutely should treat self-inflicted diseases - things like lung cancer from smoking, liver disease from drinking, or obesity-related conditions.

First, most diseases have some lifestyle component. Where do you draw the line? Heart disease, Type 2 diabetes, even some cancers - they're all influenced by choices we make. If we excluded self-inflicted conditions, we'd barely treat anything.

Second, it's really hard to determine how 'self-inflicted' something truly is. Addiction is a disease, not just a choice. Social circumstances, mental health, education - all these affect the decisions people make about their health. During my care home placement, I saw how complex people's relationships with alcohol and smoking were - it wasn't just about willpower.

Third, on public health grounds, we need to treat conditions like hepatitis or HIV regardless of how they were acquired, to prevent spread.

Yes, resources are limited and it's frustrating when people don't take responsibility for their health. But denying treatment would be impractical, unfair, and undermine the core NHS principle of care based on need. That said, I do think there's a role for encouraging personal responsibility. The NHS should support smoking cessation programmes and alcohol services alongside treatment. But withholding treatment would be punitive rather than helpful, and would likely make problems worse - people would avoid seeking help early when intervention is most effective. Equal treatment doesn't mean consequence-free, but it does mean compassionate

10.12 Should alcoholics and smokers receive equal treatment to those who don't drink and don't smoke?

"Yes, I think alcoholics and smokers should receive equal treatment. The NHS principle is care based on need, not on how deserving someone is.

Also, addiction isn't simply a lifestyle choice - it's a medical condition in itself, often linked to mental health issues, trauma, or social circumstances. During my care home placement, I saw how complex people's relationships with alcohol and smoking were - it wasn't just about willpower.

From a practical standpoint, where would you draw the line? Do we refuse treatment to someone obese? Someone who doesn't exercise? Someone injured playing rugby? Nearly every condition has some element of personal choice involved.

That said, I do think there's a role for encouraging personal responsibility. The NHS should support smoking cessation programmes and alcohol services alongside treatment. But withholding treatment would be punitive rather than helpful, and would likely make problems worse - people would avoid seeking help early when intervention is most effective. Equal treatment doesn't mean consequence-free, but it does mean compassionate

10.13 What are the arguments for and against the sale of tobacco?

"There are arguments on both sides. For allowing tobacco sales - there's personal liberty, the right to make your own choices about health risks. It also generates significant tax revenue. A total ban would likely create a black market, making things harder to control and potentially stopping people from seeking medical help.

However, the arguments against are compelling. Tobacco causes serious diseases that drain NHS resources, potentially canceling out the tax benefits. Crucially, passive smoking affects others who haven't made that choice - including children and babies who can develop addiction through exposure.

I think an outright ban is impractical and would drive it underground. The current approach of heavy taxation, public smoking bans, education campaigns, and graphic warnings on packets seems more sensible. It balances personal freedom with protecting others and ensuring people make informed choices. We should keep tobacco legal but heavily regulated, while supporting people who want to quit."

10.14 How do you go about researching something you know nothing about?

10.15 How do you know what you don't know?

That's a great question - it's something I've thought about a lot. There are things I know I don't know, and things I don't even realize I'm missing.

For gaps I'm aware of, I actively seek them out. I compare myself against what's expected - like checking syllabi, getting feedback from tutors, or seeing what my peers can do that I can't. During my paediatric placement, I realized I knew very little about chronic paediatric conditions, so I read up on them and asked doctors questions.

For things I don't know I don't know - that's trickier. That's where feedback is crucial. When tutors at Explore Learning pointed out gaps in my teaching approach I hadn't noticed, it opened my eyes. Learning from mistakes helps too - my example about giving a student answers rather than helping her understand showed me I didn't fully grasp what effective teaching meant.

Once I identify gaps, I actively address them - reading, asking questions, seeking extra experience, and most importantly, staying curious and humble enough to recognize I'll always have more to learn.

10.16 Should the NHS fund non-essential surgery?

"This is tricky because 'non-essential' is really subjective. Cosmetic surgery might seem non-essential, but what if someone's severely depressed because of how they look? Or what about breast reduction for someone with chronic back pain - is that cosmetic or medical?

I think there's a case for NHS funding when there's clear psychological or physical impact. Treating the underlying issue - whether that's body dysmorphia or physical pain - can prevent bigger problems later. Also, if people can't access safe NHS procedures, they might go abroad for cheaper, riskier surgery and end up needing NHS help with complications anyway.

However, with limited resources, we need boundaries. Purely cosmetic procedures with no medical justification would open floodgates and divert funding from essential care. The key is having clear criteria based on clinical need rather than want.

I think NICE guidelines help here - they assess whether interventions provide enough benefit to justify the cost. It's about balancing individual needs with fair resource allocation for everyone

10.17 Would you say that Medicine is an art or a science?

"I think Medicine is both a science and an art. The scientific foundation is crucial - understanding anatomy, biochemistry, how drugs work, interpreting test results. Medical knowledge is built on rigorous research and evidence.

But applying that knowledge is an art. During my paediatric placement, I saw how two children with the same diagnosis needed completely different approaches. One anxious eight-year-old needed the doctor to show her the equipment and distract her with stories about school before she'd cooperate with testing. That's not something you can learn from a textbook - it requires empathy, creativity, and reading the situation.

Communication is definitely an art - breaking bad news, building trust, explaining complex ideas in ways patients understand. At Explore Learning, I learned that even teaching fractions requires creativity to connect with each individual student.

So while the knowledge base is scientific, the practice of Medicine - managing uncertainty, working with people, adapting to each unique situation - that's where the art comes in. The best doctors combine both."

10.18 How do you solve the problem of transplant organ shortage?

There are really two approaches - either find alternatives to real organs through research, like growing organs or using animal organs, or increase organ donations, which is more realistic in the short term.

The main barrier is people's discomfort with donation, often for religious or psychological reasons. Currently we rely on opt-in donor cards, which depends on altruism.

Some countries have tried opt-out systems where everyone's a donor unless they actively refuse. This increases donations but raises ethical questions about autonomy after death. Financial incentives are problematic - they could lead to organ trafficking and exploit vulnerable people.

I think the best approach is changing attitudes through education and making organ donation conversations more normal. An opt-out system with clear religious and personal exemptions could work well, as it respects autonomy while making donation the default.

We could also explore reciprocity schemes where donors get priority if they need organs themselves, though that does disadvantage people who can't donate due to health conditions.

10.19 Ten years ago, most doctors wore white coats. Now, few of them do. Why is that?

White coats were originally worn for practical reasons - they were easy to wash frequently for infection control and helped identify doctors quickly, especially in emergencies.

The shift away from them happened for two main reasons. First, there's been a move toward more patient-centered care. White coats can create a barrier between doctors and patients - they're quite formal and can be intimidating. Many doctors switched to suits and ties, or smart casual clothes, to seem more approachable and build better relationships.

Second, ironically, infection control became a reason to stop wearing them. White coats, suits, and especially ties can harbor bacteria because they're not washed daily and come into contact with multiple patients. During my paediatric placement, I noticed doctors wore short sleeves with no ties - that's become the standard in many hospitals now, along with 'bare below the elbows' policies.

It's interesting how something introduced for hygiene reasons was eventually abandoned for the same reason, alongside changing ideas about the doctor-patient relationship

10.20 Why do you think that life expectancy in the north of England is 5 years less than in the south according to statistics?

This comes down to social determinants of health rather than just healthcare access. The north has historically been more industrial with higher unemployment and lower average incomes compared to the more affluent, service-based south.

Lower income is strongly linked to lifestyle factors - higher smoking rates, less healthy diets, more stress - which are major contributors to heart disease and lung cancer, the UK's biggest killers. There's also often lower health awareness, meaning people might engage less with prevention messages or be less compliant with medication.

Access to healthcare does play a role - there are more rural areas in the north - but I don't think that's the main driver of such a big difference.

It's important to note these are statistical trends across populations, not individual cases. Obviously plenty of people in the north live very healthy, long lives. But on average, socioeconomic factors create these disparities, which is why addressing health inequalities requires looking beyond just healthcare provision to tackle poverty, education, and employment."

10.21 Why do you think it is that we cannot give a guarantee that a medical treatment or surgical procedure will be successful?

Medicine deals with incredibly complex biological systems, and every patient is unique. Even the most skilled surgeon performing a routine procedure can't control all variables.

First, 'success' itself is subjective. A doctor might view an operation as successful because it achieved its medical goal, but the patient might be disappointed if they're left with pain or scarring. Their expectations might have been different.

Patient factors matter hugely - underlying health conditions, how they respond to medication, whether they follow post-operative instructions. During my paediatric placement, I saw how adherence varied massively between families, which affected outcomes.

There are also unpredictable factors - complications can arise, patients might react unexpectedly to anesthesia or medications, or rare conditions might not respond to standard treatments. Not everyone responds to paracetamol for headaches, for example.

Medicine isn't like fixing a car with predictable parts. We're dealing with living, variable systems. Doctors can give probabilities based on evidence, but guaranteeing specific outcomes would be misleading and impossible given the complexity involved

10.22 What do you think would be the advantages, and difficulties, for a person with a major physical disability (e.g. blindness) wishing to become a doctor?

"I think there are definite advantages. People with major disabilities often develop compensatory strengths - a blind person might have exceptional listening skills and attention to detail when taking histories. They'd also bring unique empathy and understanding when treating patients with disabilities. During my paediatric placement, I met a doctor with Tourette's treating a teenage girl with the same condition - the shared experience created instant trust and understanding that was really powerful.

However, there are practical challenges we can't ignore. A blind doctor couldn't visually examine patients or read imaging independently. Someone with severe mobility issues might struggle in emergency situations. Patient safety has to come first.

That said, Medicine is incredibly broad - there are roles in research, public health, psychiatry, or specialties where reasonable adjustments could work. Technology is also changing what's possible.

The key is matching individuals to appropriate roles where they can practice safely and effectively while being as inclusive as possible."

10.23 Do charities have a role in society or do you think that the government should decide where all the money should go?

I think charities absolutely have a role alongside government funding. Charities allow people to support causes that matter to them personally - maybe because they've been affected by a specific condition. They're often more nimble and innovative than government, can raise awareness effectively, and are directly accountable to their donors.

Government funding tends to go toward issues affecting the largest numbers, which makes sense for public money. But that means rarer conditions or smaller causes might get overlooked without charities filling that gap.

There are downsides to charities - some spend too much on overheads, there can be duplication of effort, and funding becomes a bit of a popularity contest where emotive causes get more than others that might be equally important.

In reality, the best system is probably what we have - a combination. Government provides baseline funding for broad public health priorities, while charities complement that by targeting specific causes, funding innovative research, and allowing individual choice in where support goes. They work best together rather than one replacing the other."

10.24 What are the advantages and disadvantages of admitting when mistakes are made?

Admitting mistakes is essential for patient safety and professional integrity. The advantages far outweigh the disadvantages in my view.

When you're honest about mistakes, you can fix them quickly by getting help from colleagues. It builds long-term trust - people know you're reliable and won't hide problems. In healthcare, catching mistakes early can prevent serious harm.

I learned this at Explore Learning when I gave a student answers instead of helping her understand. When the experienced tutor noticed, I admitted what I'd done rather than making excuses. Yes, it was embarrassing and I got feedback from my manager, but it meant we could properly address the student's needs and I learned a crucial lesson about what real teaching means.

The disadvantages exist - you might face consequences, lose trust temporarily, or damage your reputation. But hiding mistakes usually makes things worse. In medicine, where patient safety is paramount, honesty isn't optional. The GMC expects it, and rightly so. Short-term discomfort from admitting errors beats long-term consequences of concealment."

10.25 Do you think it is right for doctors to have conferences, training sessions and study material sponsored by pharmaceutical companies or other corporate sponsors?

This is about balancing professional integrity with practical realities. There are benefits - education budgets are limited, and sponsorship allows doctors to access training they might otherwise miss. It also helps them learn about new treatments and research.

However, there's an obvious conflict of interest. Pharmaceutical companies sponsor education hoping it influences prescribing behavior - otherwise they wouldn't do it. There's risk of bias if they only support speakers favorable to their products, and doctors might feel subtle pressure to prescribe certain drugs.

I think limited sponsorship is acceptable with safeguards. A conference registration fee paid by a company? Probably fine if the content is balanced and evidence-based. An all-expenses luxury trip abroad? That crosses a line into inappropriate influence.

The key is transparency and awareness. Doctors need to recognize the potential for bias and actively guard against it. Sponsorship for educational value only, not gifts for spouses or lavish perks. The GMC has clear guidance on this, and following those rules protects both professional integrity and patient interests while maintaining access to education.

10.26 Do you think it is appropriate for doctors to accept small gifts from patients as a thank you gesture?

This depends on the gift's value and intent. The key question is whether it could influence your judgment or compromise professional integrity.

A small box of chocolates from an elderly patient you've treated for years? That's clearly a genuine thank you with no strings attached, and refusing might actually damage the relationship. But £500 in cash? That could create obligation or the appearance of impropriety, even subconsciously.

Most trusts have policies on this. Generally, small gifts in kind - flowers, chocolates under a certain value - are acceptable. Anything substantial, especially cash, should be politely declined or donated to charity or the ward fund. When in doubt, discuss with your practice manager.

The approach I'd take is: consider the intent behind the gift, the value, and your relationship with the patient. If accepting it could make me treat that patient differently, or make other patients feel I'm playing favorites, I shouldn't accept it. It's about maintaining trust and professional boundaries while being sensitive to patients' genuine gratitude. When uncertain, always seek senior advice."

10.27 You are the Health Secretary and you have a budget of £10m available to you every year. With that budget, you will be able to make a treatment or procedure available on the NHS. You have been given the choice between only two options: a treatment that will considerably alleviate the pain of arthritis sufferers and a surgical procedure designed to repair a hole in the heart of neonates. Both treatments/procedures have exactly the same overall annual cost. What would you do?

This is an impossible choice with no right answer, but I'd need to consider several factors.

For the neonates, it's literally life or death - without treatment they won't survive, and most families couldn't afford private care. They'd potentially gain 80+ years of healthy life.

For arthritis sufferers, it's about quality of life - significant pain relief that could help people work, be independent, and contribute to society. Though they have other treatment options, even if less effective.

I'd also need to know the numbers - does the £10 million treat 10 neonates or 10,000 arthritis patients? That scale matters when considering societal benefit.

From a purely utilitarian perspective, saving young lives that contribute for decades might seem to offer more value. But ethically, can we really say one group's suffering matters less than another's survival?

Honestly, if I were Health Secretary, I'd probably advocate for the neonates given it's life-saving, but I'd simultaneously push for additional funding for arthritis treatment because this shouldn't be an either-or choice when both needs are legitimate."

10.28 Do you think it is right for patients to make the choice as to what is in their own best interest?

I think patients should absolutely be involved in decisions about their care, but it needs to be a shared decision-making process rather than patients deciding completely alone.

Patients know their own values, priorities, and what matters most in their lives. During my paediatric placement, I saw how involving families in treatment plans - like choosing between different management options for constipation - led to better adherence because they understood and agreed with the approach.

However, patients don't have medical training. They might not fully understand risks, benefits, or alternatives. They could be influenced by inaccurate internet information or well-meaning but misguided advice from family.

The ideal is informed consent and shared decision-making. Doctors should present evidence-based options clearly, explain pros and cons in understandable terms, and help patients make choices aligned with their values. But doctors also have a duty to guide patients away from harmful decisions.

It's a partnership - doctors bring medical expertise, patients bring knowledge of their own lives and values. Neither should make decisions completely independently

10.29 People are living longer. Should doctors take credit for it?

Doctors deserve some credit, but not all of it. Medical advancements have definitely contributed - we can now manage diseases like HIV that were once fatal, treat cancers more effectively, and prevent many deaths through better treatments.

However, increased longevity isn't just down to doctors. Research scientists and biochemists drive many medical breakthroughs. Nurses, physiotherapists, and other health professionals often have more regular patient contact and contribute hugely to outcomes - I saw this firsthand during my paediatric placement with the multidisciplinary teams.

Beyond healthcare, public health improvements matter enormously - better sanitation, nutrition, housing, workplace safety. Health promotion comes from teachers, charities, and government campaigns, not just doctors. Patients are also more educated and proactive about their health now.

So yes, doctors play an important role, but increased life expectancy is really a collective achievement involving the whole healthcare system, public health measures, and societal improvements. Taking all the credit would be unfair.

10.30 Should doctors have a role in regulating contact sports such as boxing?

"I think doctors absolutely should be involved in regulating contact sports like boxing. The reality is these sports will happen regardless of medical opinion, so it's better to have doctors involved ensuring safety than standing aside on principle.

Doctors can influence regulations - things like mandatory health checks, concussion protocols, stopping fights when injuries occur, and ensuring proper medical cover at events. By being involved, they're applying the principle of harm reduction and beneficence.

Some might argue doctors shouldn't condone activities that cause harm, but that's too simplistic. We don't refuse to treat rock climbers or rugby players. Doctors should be non-judgmental about people's choices while working to minimize risks.

If doctors withdrew from boxing, the sport wouldn't stop - it would just become less safe. Fighters would have less protection and oversight. Our role isn't to judge lifestyle choices, but to provide the best possible care and safety measures within the reality of what people choose to do."

10.31 Should doctors show a good example to patients?

"I think doctors should generally try to set a good example, but within reason. If a doctor is advising patients to stop smoking while smoking themselves, that undermines credibility and trust. Patients are less likely to take health advice seriously if they see clear hypocrisy.

However, doctors are human too and shouldn't be held to impossible standards. Having a burger occasionally or a glass of wine doesn't make you a hypocrite - it's about overall lifestyle patterns, not perfection. The key is moderation.

The real issue is that patients often make snap judgments. If they see their doctor eating something unhealthy once, they might assume that's their normal diet. But doctors can't live under constant scrutiny, policing every choice in case a patient sees them.

Ultimately, doctors should aim to practice what they preach in broad terms - maintaining reasonable fitness, not smoking, managing stress. But expecting perfection in every health behavior is unrealistic. What matters most is giving evidence-based advice professionally, regardless of personal choices.

10.32 60% of medical school applicants are female. Why do you think that is?

There are several factors at play. First, statistically there are more girls than boys at age 17 anyway, and girls tend to achieve better exam grades on average, which helps with competitive applications.

Medicine has also changed significantly. The introduction of working time limits and more flexible training options makes it easier to balance a medical career with family life, which historically was a barrier for women. Part-time and flexible posts, especially in general practice, have opened up the profession.

Government campaigns have actively encouraged women into Medicine after it being male-dominated for so long. That cultural shift, reinforced by teachers and role models, has made a real difference.

There might also be differences in what attracts people to careers. Medicine appeals to those interested in building relationships with patients and making a direct difference to people's lives. Some men might be drawn more to higher-paying fields like finance or law.

Ultimately, it's probably a combination of all these factors - better academic performance, improved work-life balance, cultural encouragement, and the nature of the work itself."

10.33 What are the advantages and disadvantages of the increasing role of nurses?

The increasing role of nurses has clear advantages. It frees up doctors to focus on complex cases, reduces waiting times, and provides better continuity since nurses often stay in posts longer than rotating junior doctors. Nurses can spend more time with patients, which I saw firsthand during my paediatric placement - they often spotted issues doctors might miss in shorter consultations. It's also motivating for nurses professionally.

However, there are challenges. Junior doctors lose training opportunities when nurses take on procedures they'd traditionally learn. Nurses work within protocols, and while they're highly skilled, they may not always recognize when a patient needs care outside those boundaries. Some patients prefer seeing a doctor, which creates tension.

The key is finding the right balance. Nurses and doctors should work collaboratively, playing to their respective strengths. When done well, extended nursing roles improve patient care, but it shouldn't compromise training or safety. Ultimately, what matters is patients receiving the best possible care from the right professional at the right time."

10.34 Why do people on aeroplanes suffer from Deep Vein Thrombosis from being still in one position, yet this doesn't affect people when they are asleep despite being in the same position for hours?

There are a few key differences. When you're asleep in bed, you naturally move around and shift positions throughout the night, even unconsciously. On a plane, you're confined to a tiny seat, often wedged between other passengers, making it much harder to move your legs and maintain circulation.

Also, flying involves additional risk factors beyond just immobility. There's reduced cabin pressure and oxygen levels, which affects blood flow. People often get dehydrated on flights - they're not drinking enough water and may be drinking alcohol, which makes dehydration worse. At home, you can easily get up for water during the night.

The duration matters too. Long-haul flights can mean 8-12 hours of sustained immobility in cramped conditions, whereas even if you sleep that long, you're moving throughout.

That's why airlines recommend getting up regularly to stretch and walk around the cabin - it's about maintaining circulation when you're stuck in a confined space with additional environmental factors that increase clotting risk."

10.35 The time that it takes to become a consultant has been decreased. What are the implications of this?

There are several implications, both positive and negative. On one hand, shorter training means we get more consultants faster, which could improve waiting times and deliver more consultant-led care, which is generally better for patients.

However, there are concerns. The same knowledge compressed into less time might mean less depth of learning or fewer opportunities to gain experience with complex cases. New consultants might be less confident or experienced than those who trained over longer periods.

There's also the subspecialization issue. Previously, a surgeon might train broadly before specializing. Now they might need to focus narrowly earlier, becoming experts in one area but potentially less equipped to handle the full range of on-call emergencies.

Finally, there's the workforce question. If we're producing more consultants faster but there aren't enough consultant posts available, we could end up with qualified doctors unable to find positions.

The key is ensuring shorter training doesn't compromise quality - making it more efficient is good, but it can't be at the expense of producing safe, competent consultants.

10.36 Do you think a doctor's enthusiasm wanes over time?

"I think it's natural for enthusiasm to fluctuate in any long career, Medicine included. Early on, everything's new and exciting - you're constantly learning, seeing different cases, developing skills. But over time, some doctors might fall into routine, especially if they're doing the same clinics or procedures repeatedly.

However, Medicine offers ways to combat that. Doctors can take on teaching roles, get involved in research, pursue management positions, or subspecialize in new areas. During my time at Explore Learning, I noticed my enthusiasm waning when tutoring became repetitive, so I created new approaches like my zoo management project for that struggling student - finding creative solutions re-energized me.

There are also challenges that could wear doctors down - difficult patients, bureaucracy, political interference. But I think being proactive helps. Recognizing when you're losing enthusiasm and actively seeking new challenges or perspectives can prevent burnout.

I'm naturally optimistic and enjoy variety, so I'm confident I'd address any plateau by finding new ways to stay engaged while keeping patient care at the center

10.37 What could be the implications of medical advancement on medical training?

"Medical advancement means there's constantly more knowledge to learn, which creates a real challenge for training. We can't just keep extending training indefinitely, so we need more efficient methods - like focusing on core skills first, then allowing specialization through fellowships.

There's also the question of when to specialize. Should doctors train broadly first then narrow down, or subspecialize early? Early subspecialization is efficient but creates problems - a hip and knee surgeon who never trained in other areas can't handle the variety of on-call emergencies.

Technology also changes what doctors need to learn. Tasks like analyzing blood samples are now done by labs or nurses, freeing doctors for complex decision-making. But there's a risk - if basics are delegated too much, doctors might have gaps in fundamental knowledge.

On the positive side, simulation technology and better teaching methods mean we can train more effectively. High-fidelity simulators let doctors practice procedures safely before touching real patients.

The key is balancing breadth with depth while using technology to make training more efficient without losing essential skills."

10.38 Is it best for a doctor to be a good clinician or a good communicator?

You absolutely need to be both - they're inseparable. Being a brilliant clinician is useless if you can't communicate effectively with patients to gather the information you need for diagnosis, or explain treatment options in ways they understand.

During my paediatric placement, I saw how crucial communication is. That eight-year-old with chest pain was clinically fine, but the doctor needed excellent communication skills to calm her anxiety, distract her with conversation about school, and reassure her. The clinical knowledge was important, but without those communication skills, they couldn't even complete the examination.

Good communication also means listening - really listening. At my care home placement with Mrs. Thompson who had dementia, I learned that sometimes sitting and chatting about her life was more effective than rushing in with procedures. Reading body language and building trust matters as much as clinical competence.

You also need communication skills to work with your team - giving clear instructions, documenting properly, handling disagreements professionally. Clinical excellence and communication aren't separate skills - they work together. You can't be a good doctor without both

10.39 Which question would you most want to ask if you were interviewing others to enter medical school?

I'd probably ask 'Tell me about yourself and why you want to study Medicine.' It's deliberately broad because it lets candidates show multiple dimensions - their motivation, communication skills, how they organize information, and what they prioritize.

A good answer would weave together their academic background, relevant experiences, and genuine insight into what Medicine involves. They should mention work experience but focus on what they learned - not just listing where they've been. I'd want to hear evidence of qualities like empathy, teamwork, resilience, and self-awareness.

I'd also listen for authenticity. Can they articulate why Medicine specifically, not just healthcare generally? Do they understand the challenges? Have they reflected deeply on their experiences?

The question tests preparation too - if you can't talk coherently about yourself and your motivation, that's concerning. It also reveals communication style - can they be concise yet comprehensive? Do they engage naturally or sound rehearsed?

Ultimately, I want to know: is this someone who'll thrive through six years of intense study and become a compassionate, competent doctor?

10.40 A long distance lorry driver has just been diagnosed with diabetes, which he needs to control with daily injections of insulin (at least two per day). He will also be required to maintain a low sugar diet. His wife is not working; they have three children under the age of 18, two of whom are at an expensive private school, and a large mortgage. Driving regulations are such that professional drivers who have insulin-controlled diabetes are required to demonstrate that their condition is under control in order to keep their driving licence otherwise they may lose their licence. What are the issues that you, as a doctor, may wish to address with the patient?

"As his doctor, I need to look beyond just the medical management and consider the whole picture - physical, psychological, social, and financial.

Physically, can he manage two daily injections and a healthy diet while driving long distances? Service station food isn't ideal, so referring him to a dietician for practical strategies would help.

Psychologically, this diagnosis is terrifying - his entire livelihood depends on controlling his diabetes to keep his licence. I'd explore how he's coping, whether he's discussed it with family, and if he needs counselling support. There might be diabetes charities or lorry driver associations that could help.

Socially and financially, he's the sole breadwinner with major expenses - mortgage, private school fees. Has he talked to his family about worst-case scenarios? Could his wife work? Have they considered alternative schooling?

The key is taking a holistic, patient-centered approach. It's not just about prescribing insulin - it's about helping him navigate the massive life implications of this diagnosis and ensuring he has the support systems to manage successfully.

10.41 For religious reasons, Jehovah's Witnesses cannot accept blood transfusions. Would you be happy to let a Jehovah's Witness die because he refused a blood transfusion?

10.42 What would you do if a known Jehovah's Witness arrived in A&E unconscious, bleeding profusely and needing an urgent blood transfusion?

"If a conscious, competent Jehovah's Witness refuses a blood transfusion, I must respect their autonomy even if I disagree. I'd ensure they fully understand the consequences, explore alternatives, and perhaps connect them with a Jehovah's Witness liaison, but ultimately their informed decision stands. It wouldn't make me happy to see them die, but I'd have to accept I'd done everything possible while respecting their beliefs.

If they arrive unconscious and bleeding, it's different. I'd stop the bleeding immediately - that's clearly in their best interest. For transfusion, I'd quickly check for documentation - a card they carry, previous hospital notes, or advance directives. I'd try to reach relatives for guidance on what the patient would want.

If there's no information and time is critical, I'd act in their presumed best interest, which likely means transfusing to save their life. I'd involve seniors and document everything carefully. Yes, they might disagree later, but saving a life when you can't obtain consent is defensible."

10.43 A mother comes to A&E with a child who is bleeding profusely and refuses to allow you to administer a blood transfusion to the child. Why do you think this may be and what would you do?

"First, I wouldn't assume it's religious - the mother might be worried about infection risk like HIV or hepatitis, or just anxious about her child receiving someone else's blood. After stopping the bleeding, I'd explore her concerns through calm conversation.

If the child is competent - maybe a mature teenager - I could accept their consent directly, though I'd need to manage the situation sensitively with the mother.

If the child isn't competent and the mother's concerns are about safety, I'd reassure her about blood screening processes and involve senior colleagues who might help her feel more comfortable.

If she still refuses and it's life-threatening, I'd treat in the child's best interest - the child's welfare overrides parental wishes when there's serious risk. For emergencies, I'd act immediately while documenting everything and involving seniors. If there's time, I'd escalate to consultants and potentially seek a court order.

Throughout, I'd involve the multidisciplinary team and legal advice if possible. The principle is clear - protect the child while respecting the mother as much as circumstances allow."

10.44 You have one liver available for transplant and must choose one of two possible patients on the transplant list. One is an ex-alcoholic mother with two young children and the other one is a 13-year-old child with a congenital (from birth) liver defect. They both have equal clinical needs. How would you go about choosing who gets the liver?

This isn't about picking one person - it's about what information I'd need to make an informed decision. The question says they have equal clinical need, so I'd look beyond that.

Biologically, I'd consider tissue matching, age and fitness for surgery, other health conditions, and risk of disease recurrence. For the mother, has her alcoholism been addressed? What's her sobriety timeline and support system? For the child, are there other conditions affecting long-term survival?

Psychosocially, can both patients adhere to lifelong immunosuppression and follow-up? The mother might struggle if she relapses, but assuming all alcoholics relapse is prejudiced - each case is individual.

I'd avoid assumptions like 'the child deserves it more' or 'the mother's children need her.' Both arguments have counterarguments. The young girl's parents would suffer her loss too.

Ultimately, this decision wouldn't be mine alone - it would involve a multidisciplinary transplant panel assessing all factors objectively. My role is gathering comprehensive information and presenting a balanced view without prejudice."

10.45 What would you do if an obese patient demanded an immediate total hip replacement, which will fail in 6 months?

"I wouldn't proceed immediately. If the hip replacement will fail in six months due to obesity, doing the surgery now actually harms the patient rather than helps them. The operation carries serious risks - infection, blood clots, even death - and if it fails quickly, they'll need revision surgery with even more complications.

My approach would be collaborative. I'd explain clearly why immediate surgery isn't in their best interest - that their weight will cause the implant to fail, meaning they'd suffer surgical risks without long-term benefit. I'd emphasize I want them to have the operation, but successfully.

I'd work with them on weight management, involving dieticians and physiotherapists, while ensuring adequate pain relief during that process. If they can reduce their weight to a safer level, the hip replacement becomes viable with much better outcomes.

If they still demand immediate surgery, I'd explain that medical decisions aren't simply patient choice - doctors must act in patients' best interests. They could seek a second opinion, but most surgeons would likely give the same advice. It's about achieving the best outcome, not denying treatment."

10.46 A young woman presents with rheumatoid arthritis. She has tried all the conventional treatments but is still having problems. Unless her symptoms improve, she will have to give up work in the near future. There is a new but very expensive treatment available. Treatment for a single patient costs as much as conventional treatment for ten patients. The drug is not effective in all patients and in some cases gives rise to a worsening of the symptoms. What do you do?

This is really challenging because there's no perfect answer. First, I'd need to know if this patient is likely to benefit or be harmed by the drug - what does the evidence say about her specific case? If there's a reasonable chance it'll help, she deserves full information about the risks and benefits so she can make an informed choice.

But we also can't ignore the cost. This treatment could help ten other patients instead, so there's a justice issue around resource allocation. However, if she loses her job without treatment, she might need long-term benefits and support, which could actually cost society more.

I think this needs a case-by-case approach - looking at her individual circumstances, clinical likelihood of success, and discussing it with senior colleagues and trust managers. It's about balancing her needs against wider responsibilities, which is never straightforward."

10.47 A 14-year-old girl presents to you asking for a termination of pregnancy. What are the issues?

"First, I'd need to confirm the pregnancy and assess whether she's Fraser competent - can she understand the implications of her decision, including the risks and alternatives? If she's competent, she can consent without parental involvement, but I'd still encourage her to talk to them if possible.

Confidentiality is crucial here, but I'd also need to explore safeguarding concerns - is there any abuse or coercion involved? If she's at risk, I might need to involve social services, though I'd discuss this with her first rather than imposing it.

Beyond the immediate decision, there's a bigger picture - her physical health, emotional wellbeing, contraception education, and ongoing support. The key is building trust so she feels safe being honest with me, which means being non-judgmental and meeting her where she is emotionally

10.48 An elderly lady refuses to take her medication for heart failure following a recent heart attack. Not taking the medication exposes her to serious risks, including possible death. She presents to your surgery with her husband who wants you to talk some sense into her. What are the issues?

First, I'd want to speak with her alone to ensure she's comfortable talking openly without her husband present - there might be things she doesn't want to share in front of him.

Then I need to understand why she's refusing. Is she experiencing side effects? Is she depressed or actually wanting to die? Maybe there are social issues - perhaps she's unhappy at home or in a care home. There's always a reason behind these decisions.

I'd also need to check if she's competent to make this choice - does she understand the risks? If she is competent and still refuses after I've explained everything clearly and neutrally, I have to respect her autonomy, even if I disagree. But by exploring the underlying issues - whether physical, emotional, or social - I might actually address what's really stopping her from taking the medication."

10.49 What would you do if a patient came to you asking for advice about a non-conventional treatment that they had found on the internet?

"My role isn't to dismiss it outright, but to help them make an informed decision. First, I'd want to understand why they're considering this - are they unhappy with their current treatment? Are there side effects? What are they hoping this new treatment will achieve?

Then I'd investigate the treatment itself - what does it contain, what claims are being made, is it regulated anywhere? I might ask them to bring the website or the product so I can research it properly, maybe consult pharmacists or have it analyzed.

Once I know more, I'd discuss it honestly - explaining any risks, warning that internet claims aren't always reliable, and clarifying how it might interact with their current medication. But ultimately, it's their choice. My job is making sure they have all the facts, not forcing my opinion on them

10.50 A patient comes to see you and requests an HIV test. What do you need to think about?

"First, I'd want to understand why they're requesting it - have they been exposed to risk through unprotected sex or needle sharing? Or are they perhaps misinformed about how HIV transmits? Understanding their concern helps me address it properly.

Timing matters too - some tests only detect HIV three months after exposure, so a negative result now might not be conclusive if the exposure was recent. They'd need to avoid risky behavior and retest later.

I'd also need to prepare them for the results - if negative, great, but let's discuss safer practices. If positive, that's devastating news, so I'd ensure support is in place and discuss how they'd cope. And if they're under 18, I'd need to explore whether there are safeguarding concerns about their partner."

10.51 You are a physician looking after a patient who was diagnosed with HIV a few months ago. You have encouraged him to disclose his diagnosis to his wife, which he has refused to do. What do you do?

10.52 What is your opinion on vivisection, i.e. testing on live animals?

"This is genuinely difficult because both sides have valid points. On one hand, animal testing has been crucial for developing life-saving treatments - we need to ensure drugs are safe before giving them to humans, and sometimes computer models just can't replicate complex biological systems.

But I also recognize the ethical concerns - animals can't consent, they suffer, and results don't always translate to humans anyway. The Northwick Park trial showed that even after animal testing at 500 times the dose, human volunteers still had devastating reactions.

I think the key is minimizing harm where possible - avoiding unnecessary duplication between companies, using alternatives like cell cultures when we can, and having strict regulations. The UK does have strong protections. Ideally, we'd move toward reducing animal use as technology improves, but right now, some testing seems unavoidable for medical progress."

10.53 Do you think it is right for parents to conceive a second child to cure a disease in their first child?

This is incredibly complex. I understand why parents would consider it - if it's the only way to save their first child's life, that's a powerful motivation, and the second child could grow up knowing they saved their sibling.

But there are serious concerns. There's no guarantee the second child will be a match, which could be devastating for everyone. The second child might feel they were born as 'spare parts' rather than for their own sake, which could damage their sense of identity and the sibling relationship.

There's also a slippery slope toward genetic selection - where do we draw the line? I think each case needs careful consideration, involving ethics committees, and ensuring the second child will be loved and valued for themselves, not just as a donor. It can't be a decision made lightly."

10.54 Do you think that the government is right to impose that the NHS should only allow the MMR vaccine rather than three individual vaccines?

"I think the NHS's position is reasonable. The evidence strongly shows MMR is safe - the studies linking it to autism have been thoroughly discredited and the doctor behind them was struck off. The combined vaccine is actually safer because children are fully protected sooner, rather than being vulnerable while waiting for three separate jabs.

From a public health perspective, the NHS has to offer what's proven most effective and cost-efficient. But parents still have choice - they can pay privately for separate vaccines if they prefer. That seems like a fair compromise - the NHS provides the best evidence-based option free, while respecting parental autonomy for those who feel strongly enough to pay.

Ultimately, protecting children and maintaining herd immunity has to be the priority, and MMR does that most effectively."

10.55 You are a junior doctor and, just before the morning ward round, you notice that your consultant smells of alcohol. What do you do?

Patient safety comes first, so I need to ensure he doesn't see patients. I'd discreetly ask a senior nurse or another consultant to help remove him from the ward without embarrassing him in front of patients. I'd also make sure any patients he's already seen are reviewed by someone else.

Then I need to report it - the GMC is clear that if a doctor is putting patients at risk, I have a duty to raise concerns. I'd speak to the clinical director or another senior consultant and let them handle it from there.

I'd also make sure he gets home safely - arrange a taxi so he doesn't drive. Throughout, I'd be supportive rather than judgmental - there might be serious personal issues behind this. But whatever the reason, I can't cover it up. Patient safety isn't negotiable."

10.56 What would you do if a colleague asked you to prescribe them some antidepressants?

"First, I need to understand why they're asking me instead of their GP. Are they struggling to find time? Are they worried it'll affect their career? Whatever the reason, I can't prescribe - not just because it's poor practice to treat friends and colleagues, but also because I'm not qualified to prescribe controlled drugs like antidepressants anyway.

More importantly, they need proper assessment and ongoing care, not a quick prescription in the corridor. I'd encourage them to see their GP, reassuring them about confidentiality, and help them find time - maybe by swapping shifts.

I'd also gently explore whether their mental health is affecting their work and patient safety. If so, I'd encourage them to speak to a senior colleague. Throughout, I'd be supportive - offering to listen and being flexible with workload - but I can't enable them to avoid proper help."

10.57 What would you do if you caught a colleague looking at child pornography on a computer at work?

"This is completely different from other colleague issues because it's illegal and involves child safeguarding. Patient safety isn't immediately at risk, but this person poses a danger to children generally.

I'd note the date and time as evidence, then immediately report it to a senior colleague who can notify management and police. I wouldn't confront the colleague directly - this needs proper investigation.

The team will need support when disciplinary action follows, and I'd help ensure we can continue functioning. If I felt action was too slow or nothing was being done, I'd escalate further.

If it were adult pornography, that's different - still inappropriate at work and against policy, but not illegal. I might chat with them first about the risk to their career, but I'd still consider reporting if it's compromising patient care or team function."

10.58 Under what circumstances would it be acceptable to lie?

"In everyday life, people tell white lies to spare feelings or avoid awkwardness, and that's generally accepted. But in medicine, lying has much more serious consequences because patients' trust and their ability to make informed decisions depend on honesty.

Lying to patients - like downplaying risks of a procedure - removes their autonomy. Falsifying research results could lead to unsafe treatments being used. So outright lies are never acceptable in medicine.

There might be rare situations where withholding information temporarily could be justified - like delaying devastating news for a suicidal patient until proper support is in place - but if they ask directly, you need to be truthful. The only 'lie' I could justify is a white lie to protect confidentiality, like telling an aggressive relative 'I don't have that information' rather than breaching patient privacy."

10.59 What can cause a doctor-patient relationship to deteriorate?

"From the patient's perspective, relationships break down when doctors are patronizing, don't listen properly, rush decisions, or fail to explain things clearly. If a doctor lies or pushes them toward unwanted options - like refusing antibiotics they're requesting - trust evaporates quickly.

From the doctor's side, it's tougher - we need higher tolerance. Patients might be rude, aggressive, racist, constantly change their mind, or not follow treatment. Many patients lie about smoking, diet, or medication compliance, but we work with that. We can't give up on patients easily.

The key difference is threshold - if a doctor lies, the relationship is immediately damaged. But if a patient lies or is difficult, the doctor needs to persist and try to understand why, because our duty of care doesn't disappear just because someone's challenging."

10.60 What are the causes of obesity and how can we stop the obesity crisis?

"Obesity mainly comes from eating more calories than we burn through exercise. Poor diet - processed foods, large portions, too much alcohol - combined with sedentary lifestyles where we sit at desks, drive everywhere, and don't exercise enough, means that surplus energy gets stored as fat.

Some medical conditions like hypothyroidism or Cushing's syndrome can contribute, and certain medications cause weight gain, but for most people it's lifestyle-based. Genetics might make it harder to lose weight, but not impossible.

To tackle the crisis, we need education in schools and through GPs, better food labeling, public awareness campaigns, and possibly taxation on unhealthy foods like fizzy drinks. But the biggest challenge is changing family habits - children copy their parents, so unless whole families change their approach to diet and exercise, progress will be slow."

10.60

What are the arguments for and against the decriminalisation of drugs such as cocaine?

Arguments against decriminalisation include that it might increase drug use - look at alcohol and tobacco, which cause huge healthcare and social costs. There's also a moral argument that legalisation sends the wrong message about antisocial behavior.

But arguments for are compelling too. Criminalisation creates a huge illegal market controlled by organized crime worth billions. Users steal to fund expensive habits - accounting for half of UK property crime. Decriminalisation could regulate the market, lower prices, reduce crime, free up prisons, and generate tax revenue for treatment.

It would also shift the response from criminal justice to healthcare, reduce stigma, enable harm reduction like clean needles, and let us address the root causes - poverty and despair - rather than just punishing users. Portugal's approach shows this can work effectively."

Do you think doctors should ever go on strike?

"This is really conflicted for me. On one hand, if doctors can't strike, employers could exploit that - imposing unreasonable hours, cutting pay, or increasing pension contributions without consequence. Other civil servants can strike, so why not doctors? And not all strikes would cause disasters - closing a clinic delays care but isn't life-threatening.

But the counterargument is strong - emergency services can't strike without risking lives. Plus, doctors are well-paid compared to most people, so striking during austerity looks tone-deaf and damages public trust. Also, practically speaking, cancelled patients just get rebooked, making other days busier, so doctors end up working harder anyway without pay for strike days.

I think limited industrial action for non-emergency services might be justified in extreme circumstances, but it should be a last resort."