There have been some complaints that the term ‘diagnostic formulation’ has caused difficulties to examiners and candidates for the MRCPsych Examination, and APIT have recently written an open letter to the chief examiner about this (Bulletin, April, p. 67). This has caused me to think about the problem, and to jot down a few thoughts (most of which I may say I have stolen from other people). Initially examination candidates were expected to submit a formulation in writing, but this is no longer the case. Examiners, however, still expect a brief diagnostic formulation. I have therefore summarized four accounts of ‘formulation’.

The Autumn Quarterly Meeting was held in London, at the London Hospital Medical College and the Royal Society of Medicine, on 16 and 17 November 1978, under the Presidency of Professor Desmond Pond.

The organization of postgraduate training programmes in individual hospitals is the responsibility of the Psychiatric Tutors. The present arrangements have evolved from the pioneering work of the late Professor Erwin Stengel in the 1950s. From these beginnings a system has developed which now encompasses almost every psychiatric hospital and unit in the United Kingdom and the Republic of Ireland, and which has indeed been adopted by other branches of medicine.

Following discussions with representatives of medical and nursing staff in September 1974, it was decided that each of the four mental hospitals of the Merseyside Region should make interim arrangements pending the construction of a purpose-built Regional Secure Unit. Three hospitals decided to open an Interim Secure Unit, the other to accept the monies offered to increase staffing levels on admission wards.

Since 1970, College assessors on consultant appointments committees have been asked to supply information on a confidential basis about applicants and those interviewed. The information includes the number of applicants, assessors' opinions on their training and experience, numbers interviewed, their quality, and the main deficiencies of all those seen; finally, the number of overseas graduates applying or short-listed. In addition, the assessors are asked to make any general comments about the interview, and these have sometimes taken the form of a letter or memorandum, paricularly when the assessor has felt unhappy about the candidate appointed.

By the 1970s three groups of psychiatric patients were receiving a particularly poor deal from the National Health Service: (a) The psychopathic patients who had never received the special facilities recommended by the DHSS; (b) A new group of patients, i.e. the difficult or dangerous psychotic patients who are now being refused admission to local hospitals, but whose behaviour is not such as to require the care of a Special Hospital; (c) The difficult or dangerous subnormal patients who could not be managed in new style or overcrowded, understaffed subnormality hospitals.

Pakistan has an area of 310,403 sq miles, consisting of four provinces and its population is over 70 million. Pakistan came into existence as a separate state at the time of Independence and partition of India in 1947. The country faced many crises which threatened its survival and political stability. Therefore, in spite of good intentions, there has been little growth of health, education and welfare services, so vital for developing countries.

Having reached the age at which the option can be exercised in my specialty, I retired, after twenty years as a whole-time consultant psychiatrist, in the summer of 1977.

A good doctor-patient relationship is central to the task of gathering information and providing treatment, especially in psychiatry. In a teaching hospital this relationship may be complicated by the presence of one or more medical students, watching in an uninvolved fashion, and possibly changing from visit to visit. If the students are seated to one side or even behind him, the patient may feel increasingly uncomfortable about exposing personal material in the absence of any visual feedback. A passive audience may be permissible in a general medical setting where information is less personal and amateur status is masked behind white uniforms. In psychiatry, however, the youthfulness and comparative immaturity of students may be heightened by casual dress and less formal clinics.