BMJ  2006;332 (13 May), doi:10.1136/bmj.332.7550.0-f

Editor's choice

Looking for leaders

Leadership in medicine is a hidden theme in this week's BMJ—the need for it (p 1161), the lack of it (p 1111), how to develop it (http://careerfocus.bmjjournals.com/cgi/content/full/332/7550/194), and even some examples of it (p 1157;p 1107).

Last week Dame Janet Smith bemoaned the lack of leadership in medicine in the UK (p 1111). Dame Janet led the inquiry into the profession's response to the murder by Harold Shipman of hundreds of his patients, and was referring specifically to lack of progress with implementing the recommendations in her report. She was dismissive of the GMC (whose president is interviewed in Career Focus this week) and criticised the "continuing silence" of the chief medical officer, Sir Liam Donaldson, whose report on revalidation, commissioned as a result of Dame Janet's report, is every day expected.

No one will envy Sir Liam his task. If anything requires leadership qualities, it is reaching actionable conclusions on an issue that continues to divide the profession, and doing so in an environment described last week by a former minister of health as a "maelstrom" of organisational, social, and scientific change and within an NHS that was "unstable, chaotic, and pressurised" (p 1111). Glyn Elwyn, responding to Dame Janet's pronouncement (p 1161), believes that even when the department of health declares its hand on revalidation, the profession will remain passive and complacent.

Dame Janet isn't the first and won't be the last to imply that there's a leadership vacuum in medicine. My predecessor, Richard Smith, wrote and spoke about the problem often. In 2003 he argued that the NHS suffers from having no single identifiable leader (BMJ 2003; 327:1421). The debate that followed is as relevant today as it was then. In his response, Chris Ham agreed on the need for clear and visible leadership at the top but said this had to be linked with the development of leadership at all levels, especially clinical leadership in both primary care and hospitals.

Lack of such clinical leadership is not just a UK problem. David Naylor chose this as the subject of his Lilly lecture two weeks ago (http://www.rcplondon.ac.uk/news/news.asp?PR_id=307). Naylor has written extensively on health services research and health policy and is president of the University of Toronto. The thesis of his lecture was that although doctors should in theory be natural leaders—bright, ambitious, articulate, and collegial—they are often poorly equipped to lead. Selection and training throughout medical careers favour individual achievements rather than consensus building. He argues that they are strong on cognitive intelligence and technical skills, rather than emotional intelligence. Doctors are good at solving problems on a case by case basis rather than at the systemic level. He says they tend to underestimate the value of other people's expertise and fall prey to assumptions about their own fallibility.

We will all know doctors who don't fit this description. But equally we will all know people who do. And who knows, Dame Janet may even be among them.

(fgodlee{at}bmj.com)

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