Crossing the line: can clinicians ever become managers?

The argument rages on over whether doctors can become managers without losing their principles. I tried my hand at management a couple of times. On the whole the arguments were not about improving services but saving money and I used to lose sleep over how to contain overspends. I was not a good manager because I put the patients first; while I was a clinical director the management board decided to move its main meeting from 8-9am to 10.30 to 12 – to allow more time for discussion, forgetting perhaps that the doctors would have to cancel clinical commitments to go. I made a fuss and the move was abandoned. When I stepped down the change was made within a month.

I was also not a good manager because I was always looking for the consequences of decisions and raising the possibilities before the decision was made. This usually delayed things, so I was sometimes unpopular. I also upset one senior manager when we considered a staff survey that suggested 40% had been subjected to some form of abuse by patients; I proposed the development of a red card system for abusers, to be told that we must consider why people abuse, and what has led them to do it, and try and understand how we might be making things worse. Talk about turning the other cheek! You will never get it to stop like that, but my accusation that this view was wishy-washy liberal nonsense raised a few eyebrows and made me one enemy for life.

Just before I left the NHS we were debating the future of my rehabilitation unit. It provided an important service to the long-term neurologically disabled, who get a bad deal generally from the NHS (as with James above) and whose “care in the community” often amounts to almost no care at all (which is why it can be so cheap). I found myself arguing that we must concentrate on selling the business to the Primary Care Trusts and thus concentrate on the bits that could make money. Afterwards I realised that I could be ditching all my low-key patients whose ongoing care is not very hip, or interesting, and felt ashamed of myself. But that’s what happens when you start on management agendas and forget the patients. However you could argue that some service is better than none. And, as you have read above, now there is none.

I went on a management course once (and still have the group photo to prove it). One thing that stuck out was the likening of medicine to chess rather than space exploration. With the latter each step leads logically and inexorably to the next. With the former, each move completely changes the possibilities. People need to realise this, and alter their way of thinking to fit the pattern.


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