DEMOLITION JOB Tredgold smiles wryly at our belated con- version
to the idea of an inquiry into medical educa- tion. If• conversion be the right word, mine took place years ago, since when I have been hoping in vain for• some initiative from the profession itself, in particular from psychiatrists who rightly deplore the present situation. Yet psychological medicine has remained a 'fringe' subject which the student can, and in many medical schools is encouraged to, side- step without jeopardising his chances. The Royal Medico-Psychological Association has shown little inclination to challenge the present curriculum, and there is no psychiatrist on the General Medical Council. It is in these circumstances that a layman feels impelled, no doubt belatedly, to tread with wary footsteps where the professionals' might have boldly marched long ago.
When I wrote of the backwardness of Britain in the teaching of psychological medicine, I had no wish to cast reflection on individual teachers. But if Dr. Tredgold considers that his subject Is accorded anything like its proper status and importance within the curriculum, we must part company. It is not only the United States which does better in this respect, but Canada, the Soviet Union, Holland and probably one or two of the Scandinavian countries. When I asked the Professor of Psychological Medicine at a Californian university (where the medical students spend more than 10 per cent. of their time learning about psychiatry) how the change had come about, he replied, 'By constantly fighting our medical col- leagues.' There is little evidence of any such will to fight -among British psychiatrists who, with a few exceptions, seem resigned to their lot.
Despite his astonishing claim that 'the bulk of doctors who qualify now have had a reasonable experience of psychiatry,' Dr. Tredgold does not oppose the idea of an inquiry. Both he and you, sir, question the appropriateness of a Royal Commission. In my view the basic assumptions of medical teach- ing need to be examined afresh. The question is not whether what is taught is taught well, but whether we arc teaching the right things. This will call for the advice not only of those senior physicians and surgeons who would be chosen almost automatically, but also of those with a knowledge of psychiatry, of social medicine, of public health and of general practice. If the recommendations are not to be quietly smothered, they must surely come from a body of great weight and authority. These require- ments seem to me best fulfilled by the appointment of a Royal Commission, but if another form of in- quiry could do the job as well, or better, 1 would gladly support it. The problem cannot be left, I suggest, to the General Medical Council, who must bear the primary responsibility for the present posi- tion. Royal Commissions need not be as slow-moving as Dr. Tredgold fears. The Mental Health Act, for all its complexities, was on the Statute Book five years after the setting up of the Royal Commission which gave it birth.
Tho institution of an inquiry into the wider problems need not delay, and might even stimulate, the provision of better facilities for GPs to gain psychiatric knowledge and experience which, as Dr. Tredgold points out, are urgently required. But the key to the mental health services of the future lies in the medical schools.—Yours faithfully, House of Commons., SW 1
KENNETH ROBINSON
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