In my first article, Coming to terms with being a consultant, I reflected on the pressures on consultants to change, and how hard this can be for people who have been working in a certain way for a long time. Here I’m going to look more closely at what exactly seems to be needed from today’s consultant, and how that differs from the consultant of old.
In the old days, you went into medicine with the expectation of being a clinician. When I was at medical school in the late seventies, there was a brand new course on medical sociology in the non-clinical programme, and a two day course on communication skills in the clinical course. All the rest was hard-nosed science and clinical skills.
Today, however, if you look at the different categories that are assessed for Clinical Excellence Awards, you’ll see straight away that being a clinician alone is not enough. If you want to be rewarded you have to be a manager, or a researcher, or an educationalist, or a service innovator. You even have to be nice to your colleagues and patients.
Many years ago I went to a course entitled ‘Persuading and influencing the verbal way’. I sat next to a consultant surgeon in his fifties, and the first task was to talk to our neighbour about why we had come. It transpired that he had been ‘sent’ by his trust. “I just don’t understand all this persuading and influencing business,” he said, exasperated. “When I want something doing I just tell the person and they do it!”
That might produce a collective wry smile these days, but he was simply exhibiting an attitude that came straight from the culture he’d grown up with. Why would you beat around the bush when you want someone to do something when you have the authority to give orders?
Those of us who have been around for a good while will have stories to tell about how, as juniors, we managed dire medical situations all on our own, often in the middle of the night. That was what was expected of you then, to cope alone. If you needed a team around you, you would have fallen at the first hurdle.
As doctors we were expected to take charge and to have all the answers, however inexperienced we were. We were also expected to take blood, fill in forms, check results and generally cow tow to our consultant. But caring for patients, looking after their anxieties and concerns - surely that was the nurses’ job?
Ok, these may be extreme examples of how doctors used to be, and you may argue that only some doctors were like that, while many others were collaborative, caring and flexible. But it would be a mistake to kid ourselves that we are anything other than products of the old order. The attitudes may be camouflaged and repressed, but they lurk in the shadows.
To throw a little light on the matter, try this. The box below gives a series of opposites in terms of working and management style. On the left are the qualities that were expected in the consultant of old, on the right the qualities that are expected of the NHS consultant of today. Print it off. You can assess your own style by placing a cross at the point on the line that best describes how you currently operate in your consultant role. You can use another colour pen to mark on the line where your heart or your attitudes (honestly) lie.
If you could wave a magic wand over the NHS of today, how would you like to be operating?
Clinician only……………………………………..clinician manager
Authoritative……………………………………..collaborative
Independent………………………………………team player
Medical supremacist………………………….multidisciplinary worker
Doctor scientist…………………………………doctor carer
The third and final article will look at some practical ways of coping with new demands and learning new skills.
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: Management
