Report of Durham conference 2014
We started with a lecture on loco-regional anaesthesia of the eye with Emile CALENDA. Some found the pictures a little alarming first thing in the morning, with fantastic views of retro-bulbar infiltrations of anaesthetic. The large number of eye operations done in France and also in UK shows the value of skilled anaesthesiologists, with a very low rate of complication, always improving due to better imaging techniques. The methods with sharp instruments were less comfortable to watch, with tiny margins for error around the optic nerve.
John ALTRIP presented on our ageing membership and ways to recruit younger doctors and students to join and remain in the organisation. Even students who attend and present in our prize competitions rarely become active members subsequently. Colleagues from France including Solveig LELEU, confirmed the benefits of E-Tandem, a method of linking anglophone and francophone students via Skype over several weeks. There were few dropouts (perhaps aided by an upfront charge reimbursable on completion of 8 sessions.) There have been 88 pairs since 2009, although again, few are now in the societies.
Anne–Clair GUYARD PEGE told us about the changes in contraceptive use in France subsequent to the most recent health scare around third and fourth generation pills. Apparently vasectomy is still barely used in France, for reasons unclear to the Anglo-Saxon part of the audience. The later pills are no longer reimbursed in France so usage has dropped further. There are now an increasing number of abortions performed which is perhaps more risky and certainly less acceptable. Highly educated women are avoiding chemical methods and less well educated ones are using no effective method at all. I found the name of a recent attitudinal study charming: FECOND!
Bruno MAGNIN introduced his daughter-in-law Marina MAGNIN, an Italian pharmacist now working in Paris, who told us about a short study she undertook among elderly users of anticoagulants. She offered sessions of education and then reviewed levels of knowledge of the drugs. Due to time and financing constraints she could not easily report on any changes in what I still call compliance.
John ALTRIP, Solveig LELEU, Caroline TRAN VAN, Colin MUMFORD, Martine CHAUFFETE, and Phillipe PERSIAUX reported on their various involvements with teaching English to French students at Caen, Angers and several Paris schools. Without exception the courses were well received by the students, and to a lesser extent by the administrations, who still seem loath to support financially the efforts of the anglophone visitors, even though in some schools the input is now intrinsic to the coursework, and is examinable. We will continue to support the work and try to recruit more visitors.
Zara BIELER updated us on the progress of the website. WordPress has been chosen for the AFMS site and we will suggest that the AMFB tries to develop a site that ties in and looks similar so that access to either will be seamless and effective.
Friday started with a wonderful session from junior colleagues. Vincent GUION who was with us last year, and who won the Jacques Foray prize, told us about his experiences in palliative care and telemedicine in Nottingham and in Stornaway. I suspect his most unexpected comments to many of us were the non-existence of third-sector involvement in health care in France. We are used to Macmillan, Age Concern etc being deeply integrated in the UK. His presentation sparkled and his English is now perfect.
Erwin TSE SAK KWUN (pneumonia), Gavish MUNBAUHAL (robotic surgery in GU), Alexandre TENDRON and Benjamin DEBUC (clinical cases from Sydney), Lucille Van De MEERSCHE (Quality of life enhancement in dementia in California), Lucinda WINGATE PAUL (cleft lip and palate) and Sanaa ZAYYAN (cervical incompetence and Shirodkar sutures in Nice) gave us excellent talks on the very varied topics mentioned after their names. We found scoring harder than ever this time, and awarded cash from the James Tudor prize fund to each of them, with Sanaa coming out first among equals.
There was an innovation on Friday with the delivery of the inaugural James Tudor Foundation lecture by Richard GRUNDY. We were thrilled with his description of the extraordinary developments in primary diagnosis, tissue classification and therapy of this most distressing of maladies. The details are too many to develop at length here. Anyone who wishes Richard’s slides can get a copy from Tony Ridge in due course. In brief, however, survival is improving but at the expense of lifelong disability in 2/3 of cases (motor and intellectual), and with an increased risk of later cancers as with any aggressive therapy regime. 10,000 life-years are lost, with a calculated 12,000 years of suboptimal survival. The majority are posterior fossa germ line cancers, and diagnosis is often delayed. Headache is not predominant but head tilting, loss of balance and loss of developmental markers commonest. Team working is the key to treatment, and the arguments for centralisation of expertise versus the difficulties for patient and family were key themes also. I will not try to précis any further at this stage!
Claire DELVAL had the task of starting off the final day after the Gala Dinner. She presented cases from her practice in Paris of food intolerance and food allergy, and gave us a clear exposition of the immunological differences between the two. It appears that many conditions may benefit from dietary change: skin, gynaecological, gut, behavioural problems, for example.
Rex MELVILLE gave his usual dramatic presentation of HIV, the skin and the mouth, with vivid pictures and even more vivid descriptions. We should be aware of persistent and more extreme presentations of common skin conditions, particularly where the response is less than normally anticipated. Molluscum contagiosum, psoriasis, seborrhoeic dermatitis and zoster are but some of the conditions we should observe carefully if they are atypical, as early diagnosis and treatment of the virus is the key to treatment of the skin and of course to long-term healthy survival. It was noted by one of our more perspicacious (older) members that the presentation of HIV now mirrors in many ways the protean presentation of syphilis that we were warned about as students.
Julian SEMPERE and Aurore CARTIER gave a most interesting talk on the sociology of medical students at Paris Descartes over several hundred years. There are social/drinking clubs where special clothes are worn, notable the <Faluche>, a cap from Bologna, and there are traditions that go back a long way, of course involving les événements in 1968. We heard about the <monôme> where demonstrations against a teacher, or a celebration of end of term takes to the streets.
Our last session was a master-class from Michel DUBUISSON about the history of the discovery of insulin, and the infighting that occurred. Once again I will not rehearse the whole lecture, but point out that the input from the Scottish Prof. Macleod was not exactly supportive and professional at least until he could get his name on the papers and collect his share of the Nobel that really was not due to him!
Overall this was another remarkably erudite, informative and eclectic few days. I worry that the increasing demands of a learning plan and a portfolio explaining every detail of learning might restrict attendance from specialists. It would be a great shame and more than that, a disgrace, if learning were to be constrained to a narrow field deemed relevant by appraisers. The variety and the cross-fertilisation of ideas, not to mention the language gain, is too important to lose, and seems difficult for some educationalists within medicine to cope with.
However, all seems set fair meantime for our next meeting in Nantes in 2015. See you there!