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Rapid Responses: Rapid Responses published:
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Leadership, Emotional Intelligence and Doctors
- Narasimhaiah Srinivasaiah (12 May 2006)
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Look no further.
- Dr. Rajesh Chauhan (12 May 2006)
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Is medicine equipped to lead?
- Christine Bundy (12 May 2006)
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In this day and age is Leadership in Medicine achievable?
- Munir E Nassar, M.D., Ph.D. (15 May 2006)
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The service needs to embrace all clinical leaders
- Paul W Buss (16 May 2006)
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Leadership in medicine in the NHS: an under recognised perspective
- BM Shrestha MS MPhil FRCS (17 May 2006)
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perhaps we don't need (what thinks of itself as) leadership
- Adrian K Midgley (22 May 2006)
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Narasimhaiah Srinivasaiah, Research Fellow Academic Surgical Unit , University of Hull, Cottingham , East Yorkshire HU 16 5 JQ
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Leadership, Emotional Intelligence and Doctors "If the blind lead the blind, both shall fall in the ditch." - Jesus Christ Dear Editor, I read with interest the editorial by Fiona Godlee on Leadership in medicine, a lacunae that is seen significantly in the healthcare system. The need for a visible & palpable leadership at all levels including primary care and hospitals is not an issue that needs a debate. The intensity of the problem is rather global. David Naylor feels that although doctors should in theory be natural leadersˇXbright, ambitious, articulate, and collegialˇXthey are often poorly equipped to lead, they are strong on cognitive intelligence and technical skills, rather than emotional intelligence. "Emotional intelligence" - A buzzword among the managerial, marketing & corporate world, is Called by various synonyms as softskills & Social skills. Daniel Goleman (1995) the author of Book called 'Emotional Intelligence' argues that our IQ-idolizing view of intelligence is far too narrow. Instead, he makes the case for "emotional intelligence" being the strongest indicator of success. He defines emotional intelligence in terms of self-awareness, altruism, personal motivation, empathy, and the ability to love and be loved, a trait not measured by IQ tests, a set of skills, including control of one's impulses, self-motivation, empathy and social competence in interpersonal relationships. People who possess high emotional intelligence are the people who truly succeed in work as well as play, building flourishing careers and lasting, meaningful relationships. He argues that our emotions play a much greater role in thought, decision making and individual success than is commonly acknowledged. ˇ§Effective leaders are made, not bornˇ¨, says Colin Powell. Qualities of leadership(Quotes) "Do we have these"? Things may come to those who wait, but only the things left
by those who hustle - Abraham Lincoln
Does the workforce in healthcare possess the above qualities? I doubt, not as much as we would have expected. Reason being not much of an emphasis is laid on development of these qualities & Skills. Also increase in the number of administrative managers is taking away the opportunity to develop these. For a healthcare establishment to be successful & efficient what it needs is just not managers but clinicians with good leadership qualities & social skills. The need for these qualities is already getting reflected in specialist job interviews. To have a bright & effective healthcare system for future we have to sow the seeds of these qualities of leadership & soft skills right from the beginning of a doctorˇ¦s professional career, may be introduce them as a part of the academic curriculum. Only time will tell whether we will be able to reap the results of what we have sown. Competing interests: None declared |
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Dr. Rajesh Chauhan, Consultant, Family Medicine, Hospital & Health Administration, and Communicable Diseases 309/9 A.V. Colony, Sikandra, AGRA - 282007. INDIA.
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Dear Editor, The days ahead are of a collective leadership, rather than just one person to deal with all the problems and the daily chores. There are too many expectations from a single person and that too varied and maybe quite tangent at that. Furthermore, too much is being expected out of the leaders and probably this is the reason for not getting one easily. Some of the reasons that are enumerated, quoting David Naylor, are probably superficial, as there is always an ounce of leadership qualities in any doctor [1]. What happens in an emergency situation – automatically a doctor takes over, with whatever experience he or she has, unless another one appears with a better experience and authority. Let alone a doctor, in such situations even the para-medics take over any situation and prevail satisfactorily. It is however in the normal times, when one is really (and desperately) searching for a leader with good leadership qualities, you may fail to find one, unless someone is nominated unanimously. Ironically the persons tasked to look for someone else may have just the requisite qualities of becoming the leader himself or herself, and they may even have volunteered to go and look for someone. All the same, they are just not prepared to take on the mantle themselves. This is happening because of the rising expectations and thereafter being singled out for every omission and commission. As a leader, perhaps you can not keep everyone happy at all times, when that is what is really expected by everyone. At the end of the day, one may just be termed in so many ways and a new search would then begin. The job of Sir Liam Donaldson is really tough. He is the one to provide solutions and then be responsible for them. Maybe if a collective responsibility is undertaken, the solutions may appear earlier and be more acceptable as that would carry the backing of the majority. Reference: 1. Fiona Godlee. Looking for leaders. BMJ 2006;332 (13 May), doi:10.1136/bmj.332.7550.0-f Competing interests: None declared |
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Christine Bundy, Senior Lecturer in Psychological Medicine/Health Psychology Medical School University of Manchester
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At last someone has the courage to deride the lack of leadership in and of the medical profession. In addition I am pleased that the role of emotional intelligence (EI) as a core characteristic in leadership is recognised. The research evidence quite clearly links the two. The call for greater attention to selection for, and development of EI in medical practitioners, will no doubt be met with scorn as those who lack it dismiss it as psychobabble. We have few good studies mapping EI to specific areas of medical practice but I know from observation at close quarters that it is a key factor in professionalism particularly probity and self-governance. On application to medical school our very able students claim to possess self-awareness which is a key construct in EI and many of us involved with selection believe most indeed do possess this attribute. Furthermore, EI can co-exist with general cognitive ability and there is no reason to suspect that to select those with high levels of EI will run the risk of admitting those less able as medical practitioners. As medical educators we need to nurture and develop this ability as they progress through medical education / training by training, modelling and mentoring. It appears that the initial level of EI that students' possess diminishes over time as they become exposed to a culture of cynicism and pressure to 'drop the caring and get on with the job'. This benefits no-one. We have to prepare our graduates for work in a highly politically charged, hostile and anti-intellectual NHS culture and stop pretending it is the utopia that it may have been in times past. Peskett & Colleagues (this BMJ issue) call for building a safety culture - one that is open and fair. This is more important now than ever before as the pressure mounts to hide lack of real understanding behind superficial knowledge, use mechanistically performed 'communication skills' as a proxy for care and compassion and where competence is something that is prized as an end point rather than a starting point for development of excellence. The culture within the NHS in general and in medical schools specifically has to change and all eyes are on medicine to take the lead or continue to collude with the erosion of humanity in health care. Competing interests: None declared |
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Munir E Nassar, M.D., Ph.D., Retired academic without portfolilio 17 Cobblefield Way, Pittsford, NY 14534 USA
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Reading the analytical editorial of Fiona Godlee(BMJ 2006;332), and the rapid response feedback of several physicians, it is with dismay that I raise the question of whether "leadership in medicine" is achievable in this day and age. In Western culture where liberty, freedom of thought and actions within the law are venerable qualities, capitalism has raised its greedy aspects and extended its activities to a new created field the "business of medicine", this is where medical leadership has lost the battle, at least in the United States, in the face of huge pharmaceutical firms, law firms, health care agencies, Health Insurance companies, Federal health regulators etc. Each of these entities, under the guise of "cost savings" and "improving medical practice" have eroded the almost sacred physician-patient relationship, informing doctors what to prescribe, to adhere to "guidelines", to buy the latest diagnostic equipment, at the expense of foregoing time honored and tested less costly, clinical skills, because, though sometimes such diagnostic equipment is essential, the former provide short cuts to diagnosis, but at an exorbitant price and technicians can inform you of the diagnosis. Physicians have failed to protect the almost sacred physician-patient contract, and closed practices to join various health care agencies, group practices governed by business administrators, and other agencies. Unless physicians combine their efforts to regain their entity, and to limit the erosion of business into medical practice, and to fight "interference" in their practices I am not certain that medical leaders, will emerge restoring the time honored medical traditions of compassionate intelligent care and devotion, far above and beyond the call of duty to each and every patient. The task ahead for medical leaders to arise and regain their respected place is of huge magnitude. Are we up to the task? Competing interests: None declared |
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Paul W Buss, Associate Medical Director Gwent Healthcare NHS Trust
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Your editorial is right - the paradox is that there has not been a more apt time for clinical leadership (including all clinical professions) to emerge across the NHS to help senior managers deliver necessary reform. With problems of financial control emerging across the NHS clinical leadership should be on the ascendency. Not since the 1962 reforms and the subsequent following (cogwheel) reports have such significant opportunities pertaining to medical leadership presented themselves. The clinical professions have been awaiting this moment - they must respond with enthusiasm but not be rash. In addition it is commensurate on senior NHS managers to recognise the need for truly combined approaches. We do have many of the right kind of clinical leaders - who understand both the clinical perspectives and the managerial difficulties facing our health service. Senior managers and the wider service however need to demonstrate their insight and embrace (not fear) those clinical staff who usually have a track record of delivery of excellent care to their patients and who simultaneously are able to lead the service by example. Competing interests: None declared |
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BM Shrestha MS MPhil FRCS, Consultant Surgeon Northern General Hospital, Sheffield, S5 7AU
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Dear Editor - I read with interest the editorial by Fiona Godlee1 which is quite relevant, but does not represent the true perspective of the leadership issue in medicine in the UK. I fully disagree with comments in the editorial, such as the lack of leadership, the presence of leadership vacuum and the NHS in the UK suffering from having no single identifiable leader. The NHS consultants, unquestionably, are the most important cohort of doctors responsible for providing the most needed day to day service at all levels and they have dedicated their whole life in learning the art and crafts of their specialties to provide an up to date care to their patients. They have always shown clinical leadership by introducing new modalities of treatment in the NHS through research and technology transfers by visiting centres of excellence, which involves enormous amount of hard work. Majority of them have been sacrificing every single aspect of their personal and family lives for the sake of their patients, without caring for any recognition and rewards, which is based solely on their conscientiousness and gratification from their achievements. Despite several limitations in the NHS, endeavours are being made to provide excellent care to the patients, which is the result of their leadership at primary care and hospital levels. The leadership in medicine differs completely from political leadership, instead, they have to solve individual patient’s problem without failure and this takes most of their time in the current system, which has been significantly affected by the introduction of European Working Time Directives in the training scheme as consultants have to carry extra responsibility now in order to maintain safety of their patients. The consultants in NHS are well equipped to lead and advance medicine, unfortunately, they are crippled by the enormous pressure of day to day service commitments and lack of recognition of the basic problems encountered in health care delivery, particularly by the administrative bureaucrats who control the resources to run the service. Leadership in medicine in the NHS is best appreciated by the personnel deeply involved in providing health care and very sparsely by others. 1. Fiona Godlee. Looking for leaders. BMJ 2006;332, doi:10.1136/bmj.332.7550.0-f Competing interests: None declared |
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Adrian K Midgley, GP Exeter EX1 2QS
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Perhaps we don't need leadership. There are no shortage, indeed a surfeit, of people declaring themselves leaders and issuing what look like orders, but it still doesn't look like a working arrangment. Where we have leadership, it does not always steer us away from trouble. In the last few decades we have both observed large functioning collaborative systems which clearly do not have any organised or very special leadership and work well, and devised formal ways of describing and discussing complex systems and large adaptive systems. People getting into positions that look like leadership in the context of the NHS all too often reduce the possible activity and innovation to that which they themselves can encompass, sometimes declaring this a virtue, and sometimes showing fear that anything they do not control may destroy their job. The leadership activity of getting out of the way and stopping anyone else getting in it has been under-practiced. Loose networks of activity may work better than any hierarchy here, and the felt wisdom of the organisation may reflect this in its distrust of those declared or declaring themselves to be our leaders. Competing interests: None declared |
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