Career Focus

Getting on in (and off on) medical politics …

BMJ 1997; 314 doi: (Published 03 May 1997) Cite this as: BMJ 1997;314:S2-7090
  1. Carl Gray
  1. Department of Histopathology, Harrogate General Hospital, HG2 7ND

    Nowhere man Carl Gray sticks his head over the parapet …

    How did that get decided? How on earth did he get elected? Why was she awarded those discretionary points? Why is the duty roster so unfair? Why is the new consultant post not funded? What are “they” up to? No one asked me!

    “Oh”, people will say, “it's politics-what can you expect?”. The haunt of scoundrels, the dishonest art, the least valued and second oldest profession: politics is not respected, especially in the glare of an election year.

    Young doctors-particularly young female doctors-may well wonder how it all works. How can they get their good ideas implemented? How can one's voice be heard in the specialty or hospital medical committee? What happened to ideals and morality? Should one enter the public life of organisations for part or all of one's career? Or is putting your head above the parapet the one sure way to get it knocked off?

    Politics large and small

    Lots of politics seem to be going on at all levels and we are not short of great issues of the day. But few of us bother to have anything to do with it, and professional societies and associations struggle to fill their committees and events, especially with doctors under 50. Political outfits everywhere are crying out for new blood and ideas. Medical elections traditionally draw a low turnout of voters. Yet most power lies in the hands of small groups of individuals-compare oligarchy (rule by the few) to “medarchy”-rule by (mostly) middle aged white men.

    Medical politics spans the range between the doings of a local medical society or BMA division through Westminster and into Europe. Politics writ large is the national drama of general elections and government policy; writ small it is the lifeblood of all organisations, and unless you are self employed, your job or partnership involves thriving or at least surviving in a political milieu. Even a small group of people will develop interpersonal politics.

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    Organisations publish their managerial structures and lines of accountability, but much business is done and information passed outside the formal structures in the bogs, bushes, and bike sheds of the shadow side. Like social insects, we play our various roles at the worker end of the beehive and are connected to formal and informal networks. Public men and women are the queen bees and selected drones: doing the business, inhabiting the corridors of power in the hive and the informal networks of influence. They also control the grubs and dish out the honey.

    Politics and management are obviously related. Management is the applied science; politics the high art. Political experience and training are the best introduction to management. The art of the possible and getting the best out of people are the basis of both.


    Training in one organisation equips for service in all and the generic skills you gain will come in useful sooner or later. The culture and jargon of managerialism-in our case general management-has permeated all aspects of life, and, in the public sector, will probably outlive its original sources in commerce and business. Get a grip on management jargon and you will hit the ground running.

    ”He knows nothing; and he thinks he knows everything. That points clearly to a political career“. If George Bernard Shaw's epithet is correct extensive academic preparation is not required. It is true that our most illustrious medical politicians are not philosophical giants-a little intellectual effort goes a long way in medical politics-but all are shrewd politicial technicians. The political knife drawer should include sharp edged meetings skills, polished chairmanship; effective public speaking; and a tool for mashing couch potatoes. Also important are techniques of persuasion and the sensitive reading of hearts and minds. Books and courses are available on most of these and some can be done for free with the postgraduate dean or the BMA. The BMA also pays expenses for attendees at all its political conferences and meetings. Apprenticeship to a master is invaluable but the dog will want to keep its bone for regular gnawing. Many medical organisations offer opportunities for beginners to enter public life at different levels (see box), and progression up the ladder is usual rather than difficult.

    You must train yourself as you go. Start with several small projects that stiffen the mental sinews; one or two will prosper. Rome was not built in a day, but you could start on a decent set of baths or at least get the hypocaust laid. Remember it is better to be the expert in a narrow but useful field, than a general factotum.

    Integrity and leadership

    Unless public life has a moral basis, its practitioners are merely tyrants freaking on control. Many were already baby dictators in their prams. Representatives must represent! Always stay within the confidence of the group, preferably using evidence based politics by means of ballots and surveys. Are the silent majority thinking deep thoughts or nothing much? Leaders must indeed create ideas and carry policies forward, but always consulting the led, and interpreting their evolving views. Medical politicians large and small should be as economical as Sir Robert Armstrong-strong medicines such as facts or the truth must be used sparingly, but early incision can release sepsis.

    “If you can walk with kings, nor yet lose the common touch…”, you will be a negotiator-able to sympathise with both sides of the argument and to reconcile the antagonists to the acceptable and lasting compromise. Nicolo Machiavelli has been reviled as an evil genius but he was honestly skilled in the arts of diplomacy and served his masters well. Once you can feign sincerity and be believed then you have become a politician, but your skills must be applied to principled purpose. An outcome grossly favouring one group or person-especially yourself-may not last long: aim for the gratifying win-win.

    A political or public life brings benefits to the individual as well as to society. Organisationally active doctors get positive reputations for getting things done and eventually even earn respect. Championing the underdog brings a sack of dog biscuits. Active doctors gain experience in the language and techniques of management, an apprentice's wand in the black arts, and some track record of achievement to fill the otherwise dreary pages of a curriculum vitae. Activists know more of what is going on, even in the human resources department; abreast of the tide of events, they are rarely drowned by sudden tsunamis. They can contribute to decisions and policy making, be consulted on important issues, and enjoy the virtuous feeling of seeing their ideas realised, or at least going horribly wrong. The profession is relatively mean with formal honours, but discretionary points and merit awards committees are keenly interested in leadership and representation of the profession and contributions to the wider work of the NHS.

    The down side

    On the other hand, public life squanders your most valuable resources-professional and creative time-without actual pay. Taking an organisational role necessarily means becoming embroiled in conflicts and disagreements: the fallout includes emotional wear and tear on the individual. Moments of anxiety, embarrassment, and rage are par for the course. The urge to do the other chap down can outweigh the actual argument: that way lies obsession.

    Giving up

    There is also angst in eventually giving up: many find themselves chained by the badge of office; their leading role or office has become a prized possession. When the tumbril calls there is bereavement. Unless-of course-your successor is your chosen favourite: Caesar is dead; long live Caesar! Perhaps the best time to go is early-in your prime and without too many mistakes. Do a Harold Wilson and resign on your chosen auspicious date. No one is irreplaceable. It is healthy to treat leaders regularly with doses of electoral salts. Do your stint and move on: younger people are already champing at your bits. There are very few top jobs. In the BMA, for example, our leaders have typically been at it for several decades and have often started very early. The interested beginner may feel intimidated by the archaic language (“Through you Mister Chairman, I raise a point of order…”), the hideous acronymic titles, and the utter boredom that otherwise decent people inflict upon their fellow humans in committee rooms. But the profession needs able men and women at all levels in its various bodies and unless more of us take a turn in medical politics, our organisational life will wither, or, even worse, be left in the hands of political enthusiasts.

    A “management course” or two has become de rigeur for the sleek CV, but real organisational work is to management theory what making love is to a sex manual: both are interesting, but the practice is the more fulfilling experience. Medical students: get some political experience. Younger doctors: get stuck in! Senior doctors: it's never too late to start! Potatoes: back on your couch! Someone else will do it for you.

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