11 minute read
The big interview
Emergency surgery
Professor Roger Kirby, the new president of the Royal Society of Medicine, on the urgent need for reform, the drive for diversity, and tackling an existential threat
Words: Viel Richardson Images: Christopher L Proctor
“If I don’t succeed in turning this organisation around by the end of my tenure, I will have to commit seppuku in the RSM atrium,” says Professor Roger Kirby, staring out from the computer screen through which so much social intercourse currently takes place. The ritualised form of suicide to which he refers first emerged among the Japanese warrior class around the 12th century as a way of preserving or restoring a samurai’s compromised honour. It is a rather dramatic statement for the new president of the Royal Society of Medicine (RSM) to make, but then he has taken over in rather dramatic times.
Originally called the Medical and Chirurgical Society of London, the RSM was founded in 1805. It has faced plenty of challenges in its long and storied history, but the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has radically shifted the goalposts. For the first time, the society faces a genuine existential treat, hence its president’s consideration of ancient Japanese swordplay.
Prof Kirby had long felt there was a need for reform within the RSM; indeed, it was one of the reasons he wanted the job. His was always going to be a reforming tenure, but the speed and nature of that reform looks very different now from that which he first imagined. “This is a very precious institution which exists to provide health professionals with high-quality postgraduate education, and my main job now is to ensure that when this pandemic is consigned to the history books the RSM scholars will still be reading about it in our library.” The problem, as is so often the case, is one of money. “We have a wonderful building at 1 Wimpole Street with three beautiful lecture halls, an atrium area and conference facilities, all of which we rent out commercially,” he explains. “We have a 50-bed hotel, plus a restaurant and bar. That is three major sources of income that essentially disappeared overnight with the lockdown. It leaves us staring down the barrel of a £4 million deficit for 2020.” With such numbers involved, it is no surprise that a cloud flits briefly across Prof Kirby’s usually sunny brow. “This situation is unsustainable for the long or even medium term.”
The new president believes that institutions like the Royal Societies tend to be conservative and too resistant to necessary change, particularly if it affects some of their more cherished aspects. For example, the RSM HQ houses the oldest and largest medical library in Europe. It is a wonderful place beloved by generations of researchers, clinicians and students, but it is not the bustling hub of activity it once was. Thousands of books and periodicals sit untouched for years as digitised facilities like MedSearch and PubMed give people remote access to papers and publications. “People do use it as a nice, quiet space to work, but they don’t look at the books. So reforming the library, making it more digital and turning that into a more engaging and interactive space will be a key priority,” Prof Kirby states. He views such changes to library services as one part of a fundamental change in the way the RSM meets its educational responsibilities, a central part of which will be the increased digitisation of its educational content.
“For historical reasons, we are far more relevant to people based in the southeast of England, and that needs to change,” he continues. “This is a multi-disciplinary organisation with access to deep expertise in all aspects of healthcare. Our committees are full of hugely qualified and experienced members with a great deal of knowledge. I believe there are many people who would be interested in sharing this knowledge, so we need to become much better at getting them heard.”
This last point is one of the foundation stones of the new president’s approach. Prof Kirby believes the RSM needs to raise its profile, that the society needs to extend its reach across all the healthcare professions in the UK and internationally. He makes the case that a wide variety of issues, not all of them medical, can impact on a community’s health and that the RSM really should be addressing them in some way. “For example, we have launched a series of webinars focused on the impact climate change is having on people’s health around the world,” he explains. “Global warming is going to affect us all. You can already see the changes it is causing, which are impacting on people’s health. We’re going to be talking about global health issues like TB, and how things like starvation and malaria link in with climate change. We are honoured that the Prince of Wales has agreed to open the series, which will involve top environmental scientists and experts on animal welfare and food production. SARS, MERS and most likely COVID
all crossed over to humans via the food system. You cannot separate the health of the planet from the health of those of us who live on it and I want the RSM to be a leader in conversations about the links between planetary and human health. I’m very excited about this series.”
On 25th May 2020 in Minneapolis, Minnesota, something happened that briefly forced even the pandemic off front pages across the world. When a police officer took approximately nine minutes to choke the life out of George Floyd in broad daylight, surrounded by dozens of witnesses, the images horrified people across the world. It led to a rise in prominence for the Black Lives Matter (BLM) movement and caused minorities across the globe to reflect on and discuss their experiences of deep-rooted discrimination.
“I know that systemic racism has been deeply entrenched in our society and that very many people of colour have suffered greatly as a result. Black Lives Matter has raised awareness,” says Prof Kirby. “It has meant that now we can begin to at least have a conversation, whereas before it was being swept under the carpet. Everybody knew there was discrimination, but nobody would mention it. Now you can be upfront about it, which I think is good. Uncomfortable, sometimes painful, but good.”
Such conversations are beginning to lead to actions. Prof Kirby reveals that the Royal College of Surgeons is in the process of an in-depth analysis of the experiences of Black, Asian and minority ethnic (BAME) surgeons, with the aim of highlighting the hurdles they face as they try to build a career. It will be interesting to see if any changes result from the finding of the report. Prof Kirby points out that at least half of newly appointed doctors in the NHS have trained abroad. Clinical staff from southeast Asia, Africa and India are common. “I bet the NHS is one of the most diverse organisations in the world, but it’s skewed because most of the top positions are held by essentially Anglo-Saxon men.” A wry smile shows that he is well aware of the fact that, as a white male himself, he has been a beneficiary of the system, but he is determined to do what he can to see it change.
“We need to widen the range of diversity in our field. When you go to a hospital ward you see this widely diverse workforce, but as you climb the
Royal Society of Medicine The Royal Society of Medicine (RSM) was established in 1805 with the aim of “uniting physicians and surgeons under one organisation to benefit from shared knowledge”. Originally called the Medical and Chirurgical Society of London, in 1907 it merged with 15 other specialist societies to create the RSM. Today the society’s role is to provide the highest quality education at postgraduate level and beyond to medical and healthcare professionals. It also provides a forum for discussing current medical issues in an atmosphere where innovative thinking thrives and the best ideas are disseminated. As a charity, the RSM receives no government support, thus ensuring its independence. It therefore relies primarily on membership subscriptions, support for its education programmes and philanthropy. During the Covid crisis, the RSM has played a key role in providing an accessible platform for sharing clear, independent and trusted medical information.
rsm.ac.uk
Communication has been the real issue throughout the COVID crisis, leading to confusion and a lessening of trust. I think we have proved to be a sorely needed source of information that people can trust
career ladder it lessens dramatically. The higher up the pyramid you get, the less diverse it is, and we have to develop ways of tackling that,” he says, with feeling. “There is this glass ceiling. It halted generations of women, but they are now breaking through. It also exists for people of colour, but I’m hopeful that the BLM movement can be the springboard to help them start breaking through as well. The RSM needs to become a champion of all types of inclusion and diversity.”
One unforeseen effect of the pandemic has been the way in which both clinical and nonclinical communities have looked to the RSM to provide some clarity and perspective in this time of such uncertainty. “Our mission is to educate and inform—skills that have become even more important in the current situation,” Prof Kirby explains. “Something we have done which I am very proud of is our COVID-19 webinars. This weekly series has seen knowledgeable and talented people from diverse fields share their expertise on different aspects of the pandemic from national and international perspectives. Our audiences are growing, and they get amazing feedback—98% of people say they would recommend the webinars to a friend or watch them again.”
Prof Kirby is right to be proud: tens of thousands of people have participated in these webinars, and the information and insight they provide have regularly filtered through into the media. They are reaching a wide and increasingly influential audience and meeting a demand for authoritative information untainted by politics. “The pandemic has created enormous challenges for policymakers, health leaders and healthcare workers on the ground. Communication has been a real issue throughout the crisis, which has led to some confusion and a lessening of trust in the messages. I think that our webinars have proved to be a sorely needed source of information that people can trust.”
Having spent years developing the skills necessary to provide the type of educational content suited to a physical presentation, the staff at the RSM have had to switch very quickly to providing digital learning of the same high academic standards, and it has been a real challenge. “We’ve had to become much more like a TV company and less like a conference venue and that’s a pretty big change,” Prof Kirby says with a wry smile. “Different equipment, different skills and occasionally different personnel. Health professionals have had to learn how to communicate online, they need to be articulate, clear and much briefer, which has been no bad thing! There’s an awful lot of re-training to do, and we still have things to learn, but I am incredibly proud of the way our staff have dealt with the challenges that faced them.”
Prof Kirby’s pride extends far beyond the walls of the Royal Society of Medicine. He is hugely impressed by the way the medical community as a whole has responded to COVID-19. “Health workers have had an extraordinarily difficult year, and they’re exhausted. Yet they still turn up every day to deal with large numbers of COVID patients while still being there for the non-COVID patients who need their care. I’m so proud of what’s been done. Even with the vaccine, it’s still going to be tough, but they’ll get through this. The NHS is a fantastic organisation, and it is beyond amazing what they’ve achieved.”
While the pandemic may have changed the nature of the job, it has thrown Prof Kirby’s belief in the need for reform into greater relief. “My job is to modernise the RSM, to make it relevant to more people, to raise its profile and to make it much more financially viable,” the new president reiterates. “We have this wonderful tradition, this amazing building in a fantastic location. Marylebone and the Harley Street Medical Area were thriving before the pandemic. They have taken some knocks but they will recover, as will the RSM. It will take hard work and imagination, but I’m looking forward to the challenge. Our response to the pandemic has shown that our people have an enormous amount of untapped talent and potential. I firmly believe that in them we have the ability to evolve into an RSM which is as relevant to the 21st century as it was for the 20th. But evolution will mean change, and it’s my job to be the leader of that change, to make sure that it is done in a way that allows us not only to survive but to thrive for another 215 years.”
Royal Society of Medicine 1 Wimpole Street London W1G 0AE 020 7290 2900 rsm.ac.uk
