Written by Derick Wade, a founder member of the BSRM.
The British Society of Rehabilitation Medicine (BSRM) is debating whether to retain that name or to change the name to the British Society of Physical and Rehabilitation Medicine (BSPRM). A brief introduction to the debate, explaining its background, and giving links to relevant documents is available here. This post will set out why I think it better to retain the name of the BSRM. A second post, here, sets out the counterargument. Readers may comment at the end of ether page, especially pointing out weaknesses or flaws in the argument put forward in this post or adding points that I have not made. This post puts forward a strong personal view. Other proponents of retaining the name may submit alternative arguments which can be published as additional posts, or as comments on this post.
Retain name of BSRM – summary
There are many arguments for retaining the name, British Society of Rehabilitation Medicine, many of which have been mentioned or implied in the so-called ‘consensus document’ (here). The main points included are that the current name, theBritish Society of Rehabilitation Medicine:
- accurately and succinctly describes the society;
- is now well-known, and it is respected nationally and further afield;
- is aligned with the name of the speciality, as recognised by the General Medical Council;
- may encourage doctors undertaking rehabilitation in other medical specialties (e.g.paediatrics or geriatrics) to join the society
This post will put forward a single argument: only by retaining our name will we preserve and increase our influence.
Retain name of BSRM
Increase our influence
I will argue that keeping our name maximises our opportunity to influence rehabilitation policies, commissioning or rehabilitation services, and development of rehabilitation services.
Considering its very small size, compared with other professional bodies that may be consulted by organisations responsible for commissioning rehabilitation or developing policies, the British Society of Rehabilitation Medicine already has, through its members, had a large influence on rehabilitation services. For example, the UK Rehabilitation Outcomes Collaboration (UKROC, see here) has greatly influenced commissioning, funding, and service organisation. The BSRM has been consulted about many national reviews and guidelines, and our feedback and engagement have had significant effects. Members of the BSRM are often the key drivers behind other guidelines such as the Prolonged disorders of consciousness following sudden onset brain injury: National clinical guidelines. Last, we have produced many standards documents and they are downloaded and used frequently. (here)
This is not enough. To increase our influence, we need to build on two facts. First, rehabilitation is characterised by being a multi-professional team activity. Second, the only truly multi-professional rehabilitation organisation in the UK is the Society for Research in Rehabilitation (SRR). We already have a close working relationship with them, with many doctors also active within the SRR. but it is not an organisation focused on influencing policies and commissioning. It is focused on research.
A truly multi-professional organisation representing rehabilitation would have much greater influence than any uniprofessional group. The Community Rehab Alliance, not (yet) a formal organisation, has already demonstrated the power a multi-professional group can have. (here) It is only about three years old, it has no formal organisational structure or membership, yet it is already involved in five work-streams with the Department of Health.
An example of an influential multi-professional organisation is the American Congress of Rehabilitation Medicine. (here) In 1966, the American Congress of Physical Medicine recognised the need to become multi-professional, and they removed the word Physical from their name. They now run very large conferences, they are building links across the world with members in 65 countries, and they are “the fastest-growing professional association in physical medicine and rehabilitation.” (They used the ‘old’ term, because in the US the specialty is still referred to by doctors as ‘physical medicine and rehabilitation’.)
Our political influence upon policy and commissioning within the UK would be much greater if we had a membership that is both larger (i.e. many more members) and more representative of rehabilitation services (i.e. not mainly doctors registered on the GMC specialty register as specialised in Rehabilitation Medicine). It is also likely that our influence internationally would be enhanced if we followed the ACRM.
Their experience was that removal of the word Physical led to significant growth in size, and thus in the influence of their organisation.
If the British Society of Rehabilitation Medicine is to have greater influence over rehabilitation policies, the commissioning of rehabilitation, and the development of rehabilitation services, we need to increase our size and power. The only way to achieve major growth in influence will be through welcoming, as full members:
- doctors working in all other specialities who undertake rehabilitation as a significant part of their work; and
- people from other professions who are expert and experienced in rehabilitation.
The experience in the US suggests this is more likely if we do not have Physical in our name.
I conclude that we must attract into the Society many doctors who are not consultants in Rehabilitation Medicine but are delivering rehabilitation in other specialties such as neurology. At the same time, we must attract into the Society people from all other professions who practice in multi-professional rehabilitation teams. If we do not do this soon, our influence will wither as other multi-professional rehabilitation organisations develop, the Community Rehab Alliance being a front runner. I also believe that adding the word Physical to our name will make it much less likely that these people will join, as it is an old name associated (fairly or unfairly) with a different, more medical and doctor-dominated approach to rehabilitation.
The remainder of this post covers, first, what both sides of the debate have in common, what we agree on. It will then discuss the areas we have different opinions about, where we have different approaches to the debate. It ends with a personal view of what the addition of the word, Physical, might say about our Society, and imply to others.
What both sides have in common
Both sides of this debate share a passionate desire to improve rehabilitation in the UK, both in terms of the quality of the services offered, and in terms of the resources devoted to rehabilitation services.
Furthermore, we all agree with many of the points made by Dr Manoj Sivan and his colleagues in his document, the Rehabilitation Medicine Expansion Proposal, (here) published in 2016:
- the number of consultants (doctors) registered as specialised in rehabilitation medicine in this country is both
- inadequate to meet the needs of patients, and
- fewer than in other comparable countries;
- rehabilitation services in the UK are
- politically weak,
- overlooked and/or given a low priority,
- poorly organised with no coherent plan nationally or in most localities
- the British Society of Rehabilitation Medicine has an important role to play in trying to improve this situation.
The first object of the British Society of Rehabilitation Medicine’s constitution is “to promote the development of the understanding and management of acute and chronic disabling diseases and injuries, and their consequences for the individual patient, their carers, their medical and other attendants, and society at large.”
This object is not worded well or clearly (!), but I interpret it to mean “to improve the quality and quantity of rehabilitation services for all patients and those affected by the patient’s disability”
We probably also agree that:
- Increasing the membership will increase our influence, increase our financial stability, and improve our ability to produce guidelines, responses to consultations etc
- Rehabilitation is entirely based on collaborative, multi-professional teamwork and working collaboratively with a wide range of other services and people.
The difference between us
The differences between us are less easily identified. Our opinions differ on the best name for the Society, but the reasons for this fundamental difference are quite unclear. Yet there must be differences because it is obvious that some people at least hold quite strong views. My own views are set out here for all to see. I hope that somebody with opposing views will have the courage to set them out in an opposing post. At present, it only has a summary of their published case. (here)
The strength of the views held suggests to me that adding the word, Physical, to the name in fact represents, for those who want the change, a much more fundamental change in the nature of the Society. It certainly feels to me that the proponents do have a different view on how the Society should develop. I will explore this
The advocates for change say that adding the adjective, ‘physical’ to the society’s name will lead to
- a greater recognition of the society, and thereby
- a greater influence within the UK, and also
- more recognition of the society internationally and, crucially
- an increase in the number of doctors wishing to join the society
Unfortunately, they do not provide any explanation as to how these changes will occur, or why the third one is of such importance:
- the terms, physical medicine and physical rehabilitation are unknown in the UK
- they are likely to reduce rather than increase recognition of the Society,
- they risk many people thinking the Society is perhaps related to physiotherapy;
- similarly, the lack of any recognition of the use or meaning of ‘physical’may
- reduce our influence, and
- may lead some people to believe that the new name is for a new, separate society;
- the extent of recognition internationally is not something I can judge, but in Europe our name is well recognised and there are other rehabilitation medicine societies, including the American Congress of Rehabilitation Medicine which runs very large annual conferences with large multi-professional audiences;
- there is absolutely no explanation of how a change in name will increase membership. It will certainly not increase the number of trainees or consultants as these are determined politically, and by commissioners and others.
I cannot speak for other people wanting to retain our present name. Apart from the fact that believe that there is no logical foundation nor any evidence to support the four suggested consequences of changing the name, I believe that:
- the present society name best represents what the society is – doctors who are interested and expert in rehabilitation;
- a change in the society’s name threatens loss of our hard-earned reputation and influence – the BSRM standards are used quite widely;
- the present society name is more inclusive and allows doctors from other specialities and other non-medical professions to join.
Thus the only true difference I can discern is that those advocating change are asserting, without either any evidence or any logical argument, that a range of benefits will follow, whereas those advocating retention of our current name are putting forward arguments to show that (a) there is no reason to expect the changes suggested by those who want change and (b) there are significant risks associated with a change of name,
What does adding physical imply?
There is, in my view, a more fundamental difference between the two camps than simply changing the name. I will now explore my hypothesis.
I am doing so because it is important that members, voters, are aware of the possible consequences of their vote. It may seem like a simple change in name, but I will argue that it will inevitably have much wider consequences, though probably not those suggested.
The specialty name.
My first concern is that, whatever is said, this vote is about changing the name of the specialty.
The consultation document (here) states that “This vote is only about a change in the name of the SOCIETY and not for a change in the name of the specialty.” Yet, in the ‘PRM’ WhatsApp group, an advocate of name change wrote “We agreed there was no need to speculate on specialty name in this document. ” and asked for the sentence to be removed. Three sentences up, in the same message, the writer referred to this change “as the first step“.
More tellingly, the summary paragraph of the proposal presented to the Executive Committee on September 30th, 2020 said:
Given the pressing issues of lack of workforce expansion and inability to meet the rehabilitation needs of UK population, we the proposal authors feel that there is now an urgent need to ask BSRM members to consider changing the name of the society, not only as a reflection of the changing practice in our services but also to move towards expansion in the full breadth of our specialty and to achieve international equivalence which has long been overdue. The change of the name of specialty can be considered as the next logical step once there is consensus among membership to change the name of society. [I made this bold.]
I conclude that, if the name of the Society is changed, then within a short time there will be moves to change the name of the specialty to match the new name. I think that any statements saying “This is only a vote on the name of the Society, and it is not a vote on changing the name of the specialty.” are disingenuous if not actively misleading.
A second theme that concerns me is an undercurrent of excluding some parts of rehabilitation and/or some people from our Society.
The expressed desire in most documents supporting a change of name is to “broaden the scope of our society” and to “expand the remit of the specialty“. This has already been achieved. The 2021 curriculum, developed from September 2016 onwards, now has a curriculum as broad as any other around the world.
In the PRM WhatsApp group posts, it is notable that, when referring to ‘broadening the scope’ most of the comments refer to “the loss of musculoskeletal rehabilitation”. Moreover, the posts often include phrases or sentences such as “They cheekily took MSK away from us, now are aiming for Long Covid.”
It was therefore surprising and disappointing to see, in the proposal put to the executive committee, that one of the disadvantages of the name, Rehabilitation Medicine is that it makes rehabilitation medicine “Indistinguishable from other medical specialities involved in rehabilitation e.g. psychiatry, drug and alcohol addiction, gerontology.”.
Table one in theRehabilitation Medicine Expansion Proposal, which underlies all the arguments put forward for change, lists the 25 top causes of disability including ‘Major Depressive Disorder’ (number 3), Anxiety disorders (no. 5), Drug use disorders (no. 8), and Alcohol Disorders (no. 12). This table was to prove the need for more consultants. It is odd that the proponents wish to exclude four of the top twelve disabling disorders from our scope.
Moreover, this statement, suggesting the exclusion of some areas of rehabilitation, contrasts with the hope, written only four years earlier, in the Rehabilitation Medicine Expansion Proposal, that we could “work collaboratively with other relevant specialties will help build a stronger specialty that can meet the variety of rehabilitation needs in the NHS.“.
It also interests me that the RMEP says “It can be argued that growth and expansion of the specialty of RM has been hampered by the emergence of multiple smaller specialties and provision of rehabilitation services being led by non-RM physicians in certain areas. We argue that these services might be better led by RM physicians whose practice is based on the ICF biopsychosocial framework.”
Surely the response to this should be to welcome all these extra people who are doing rehabilitation into our Society, rather than saying that other people who are undertaking rehabilitation have “hampered” the growth of Rehabilitation Medicine and our Society.
Indeed, this would be the quickest way to increase the membership of the Society. The proponents of adding ‘Physical’ say of the change in name. “It is our assertion that we will increase our society membership by attracting clinicians from Sport and Exercise Medicine (SEM), Pain, Cancer Rehab and Cardiopulmonary Rehab to join us that enables us have a greater impact as a society on disability care and health policy.” Why depend upon an assertion, when we can immediately start to encourage the many doctors already delivering rehabilitation to join our Society.
There is also an underlying theme of competition not only with other medical specialties but also with other professions. In comments in the WhatsApp group discussing the name, one sees comments such as “no expertise in the area, naughty AHP consultant involved, no plan to prove the point.” and “The next thing to happen is they will open these fellowships to AHPs and they become AHP consultants in neurosciences.”
I have suggested several times over the last 12 months (e,g, here on November 18th 2020), including at the Executive committee meetings, that we should encourage these other doctors and other professions to join us. Members on the executive who want name change have not discussed or taken forward this means of increasing membership.
I conclude that the desire to change the name reflects a desire, in some of its proponents, to make the Society more exclusive, not attractive to the many other doctors undertaking rehabilitation but only attractive to doctors who wish to identify with ‘Physical and Rehabilitation Medicine’. I am also certain that many others who favour the name change do not hold this view and would also like a broader membership.
Conclusion. You must vote.
I will conclude by saying to all members of the BSRM, please vote in the ballot. This vote is about far more than the name of this Society. It is about the heart of the Society, what the Society stands for and what its future looks like. I believe that retaining the name, the British Society of Rehabilitation Medicine, will allow it to continue and grow as an inclusive Society, with a broad, multi-professional membership able to represent rehabilitation where it matters. I believe that adding the word, Physical, risks reducing its appeal to a broader membership, and suggests a less inclusive society focused on specific medical treatments. But, even if you disagree, please vote.