NHS consultants are no strangers to change, so the implementation of the 48 hour week should not come as any great shock to the system. After all, we’ve handled regular restructurings, wholesale changes in the way out-patient appointments are booked, skill-sharing with other professions, less junior support and more on call, to name but a few.
And yet, how often do we reflect on the effects of all this change on our day to day working? How often do we stop and think about how we’ve adapted over the years, and how often do we try to anticipate what a new development is going to require of us personally?
Looking back, it’s interesting to ponder on what the changes have meant for the average hospital consultant; and here you find some paradoxes. On the one hand, consultants are encouraged more and more to contribute to the management of their service, simply maintaining a good clinical service is not enough. On the other hand, consultants arguably have less authority than ever before. Ask a consultant ten, fifteen years ago who their line manager was and they would probably have laughed at you. And that’s only the ones who knew what ‘line manager’ actually meant. More recently appointed consultants are quite accustomed to seeing one of their colleagues as their boss.
In clinical work there has been a trend away from independent working towards team work, and not only medical teamwork, but multidisciplinary team work. Yet, for the most part, the buck for clinical decisions still stops at the consultant. Because of changes in clinical training, and because juniors work fewer hours, they do less and less of the low level tasks. This means that consultants, while managing more at the top end, are also clerking patients and ordering investigations. More paradoxes.
The way consultants are expected to relate to patients has also changed. The expression ‘person-centred’ may have as many meanings as the people who use it, but one thing is certain - it is no longer enough simply to provide a scientifically sound diagnosis and treatment.
So the modern NHS consultant needs to be not only different from the old version, but considerably more. If you have been a consultant in both the old and the new orders, how have you coped with these changes in expectation? Have you moved easily with the times, adapting your style, and if so, what changes have you made, specifically?
Alternatively, have you dug your heels in, or drawn a circle around yourself within which you hope to continue operating in the way you always have? Whichever route you have taken, and most people will have struck some kind of a balance between the two extremes, how has that been for you?
One thing that doesn’t seem to have changed at all is the expectation that doctors think of themselves as tough people who, in all circumstances, cope. But change is difficult, and if kindness and support in that change is not forthcoming from the system, then doctors have to provide that for themselves. If you have been in the system for a while, operating in a way that seems to be required of you, it’s very tough to find yourself suddenly in the wrong.
Give yourself a little compassion. And if you are managing someone like that, try to understand that their rigidity and lack of cooperation is purely a defence. Underneath that defence lies a repository of sadness for what has been lost, and fear of what is to come. These feelings need to be dealt with before anyone can change.
The next article in this series on management will examine what is required of a modern NHS consultant.
Anita Houghton provides career and management coaching for doctors and other professionals, and is author of Finding Square Holes, a self-help book for career development, available at www.workinglives.co.uk/articles.htm
Tags: Consultant role, Leadership, Management
