THE FOUNDING OF FORUMS IN THE ROYAL SOCIETY OF MEDICINE

Extracted from Dr Luke Zander's valedictory address as retiring president of the Section of General Practice, 27 October 1981.

The function of the RSM as a unifying force in an age of rapidly increasing specialisation is one of great importance and significance. If its meetings are to be characteristic of the Society, rather than isolated events dependent on individual members' imagination and energy, a new structure must be found which will not only facilitate but actively encourage the development of this unifying approach. It is suggested that the Society should establish a number of Forums which are related to a specific topic, in contrast to the Sections, which relate to a particular discipline.

These Forums would necessarily be multidisciplinary, and therefore this important aspect of their function would be built into their structure and thus be quite independent of the professional roles of their members. In the spring of this year we held a three day multidisciplinary conference on "Pregnancy care for the 1980s" together with the Section Of Obstetrics and Gynaecology. Participants were drawn not just from general practice, obstetrics, paediatrics and midwifery, but also included health visitors, psychologists, educationists, sociologists and those representing the interests of the mothers who receive the care. The conference, with its unusual range of disciplines represented not only on the platform but also amongst those attending, was generally considered to have been an unqualified success. However, it is relevant to mention that although the meeting was widely publicised and oversubscribed, the number of attending obstetricians was very small. This was a cause for both disappointment and concern. Disappointment stemmed from the fact that those who have taken on themselves the responsibility for providing pregnancy care should regard a ground-breaking meeting of this nature to be of little interest. The concern, however, was more fundamental and of wider significance, in that it raises the question of how we are to ensure that those taking the decisions concerning the delivery of care have the appropriate depth and breadth of knowledge and experience. This is a question that is in no way restricted to the issue of obstetrics, but rather is of critical importance to the delivery of medical care as a whole. It is important that we in the profession realise that we must make decisions about the service in which we are engaged that are free of bias and self-interest if we are to satisfy the needs and demands of those whose interests we claim to have at heart. It is essential that we exhibit a willingness in listening also to hear the views of others. The establishment of a forum on pregnancy care takes the issue away from the umbrella of one or another discipline; it becomes the focus of analysis and discussion by a wide range of different disciplines, in a non-hierarchical way.

What should the activities of such a forum be? These could take many forms. It could arrange meetings or conferences in the normal way, or organise seminars aimed at providing a teaching role, at undergraduate or postgraduate level. It could serve the function of an information centre, both for the collection and distribution of information, and at times to assume an advisory role, publishing reports and monographs under the Society's aegis. One of the important characteristics of the RSM in this regard is that it has its own channel for publications. At a different level it would be possible to imagine a situation whereby such a forum could act as an important means by which major policy initiatives of either the professions or even government could be reviewed from a multidisciplinary perspective, a possibility which does not exist at the present time. If these functions are to be realised, it is essential that such a grouping meets on neutral ground, and it is difficult to imagine a more ideal setting for this than the RSM. A memorandum summarising some of these ideas has already been submitted to the President of the Society, Sir John Stallworthy, and he has been most encouraging in his support. It has also been considered by Council, who gave it their unanimous approval.

Preliminary steps have now been taken with regard to the establishment of the first of these Forums, to be concerned with pregnancy care, and the initial meeting of a steering committee has already taken place; this brought together two obstetricians, a paediatrician, two midwives, a clinical psychologist, two general practitioners, an epidemiologist, a sociologist and the president of the National Childbirth Trust. That group has begun to consider such issues as the activities to be undertaken, how to ensure the multidisciplinary structure, how the Forum would relate to the existing structure of the Sections, and the question of finance.

Topics which seem suitable for consideration by Forums include child care and the management of mental health. An existing Section which might perhaps better be considered as a Forum is that of Medical Education. One could believe that great benefit could be derived if this brought together not only those within the medical profession active in this field, but also members of the paramedical professions together with educationists, psychologists and experts in a range of teaching methods.

Let me say just one word about the Open Section, and how this relates to and differs from the concept of a Forum. The establishment of the Open section has marked a major step forward for the RSM, bringing together individuals from both within the professions and from outside, to consider issues of general concern. In this sense it does indeed have a multidisciplinary structure. The difference between this and a Forum lies in the fact that it is not a working group, where specific topics provide a continuing focus for consideration. However it is very much to be hoped that members from outside the professions will take part and provide valuable input into the deliberations of these Forums.

Over the years the idea of an academy of medicine has been raised frequently, as it was in the recommendations of the Wolstenholme report. In 1973 a leading letter signed by the presidents of the Royal Colleges was published in the BMJ, together with a long editorial suggesting the establishment of such an institution, and in 1979 similar correspondence took place. In both instances the idea was based on the notion that representatives of the various medical institutions and colleges should come together in such an academy; this would then serve the function largely of improving communication, but there is little in the suggestion to give one confidence that it will be a means of breaking down the barriers that already exist.

The difference in and the strength of the forum idea is that it will bring together people who are striving to find ways of approaching a common problem. No similar organisation exists anywhere, as far as I know, either in Europe or in North America, and if its potential is realised it will add a very special purpose to the RSM, ensuring not only its own development but giving it another significant role to play on the medical stage. No such scheme will work unless a sufficient number of people care enough about the Society to give their time, energy and imagination to it, and to accept the challenge that this opportunity represents.