Views & Reviews The Bigger Picture

There is nothing like the real thing

BMJ 2008; 337 doi: (Published 20 August 2008) Cite this as: BMJ 2008;337:a1346
  1. Mary E Black, public health physician, Belgrade, Serbia
  1. drmaryblack{at}

    I have been involved in competitive sailing for years. Equipment, tactics, team psychology, logistics, nutrition, medical support—I can discuss all these and give you my measured and informed opinion. Give me a team trip to organise or a race strategy to review and I can throw my weight around. For I have seen it all either from the harbour, through my binoculars, or up close from a judge’s boat. But this week was the first time I had competed. And, believe me, nothing had prepared me for the real thing: the adrenaline rush and naked aggression of the starting line, the constant loud noise of flapping sails, getting hit on the head with a flying boom, the thrill of winning. It also came as a shock to be valued mainly for my contribution as obedient, non-verbal ballast and minor rope tweaker.

    In medicine you can analyse problem based learning cases, suture artificial skin, even do brain surgery via computer simulation. But the day you get your hands dirty is when you put all that theory into practice. Nothing can quite prepare you for the sticky consistency of blood, the smell of singeing bone as the drill cuts through, the emotional despair of grieving parents, the irritation caused by difficult colleagues, or the sickening awareness of your first big mistake. And no simulation can recreate the satisfaction of a five hour operation when that last line of sutures goes in, being in an effective resuscitation team, enabling a terminally ill man to stay at home with his beloved wife supported by home nursing, or diagnosing measles.

    Audits and management reviews are necessary and useful. But they are as far from the dirty, tough, exhilarating, fantastic, rewarding reality of teamwork health care as I was from competitive sailing when sitting there on the sidelines with my binoculars. The best managers are aware of this; the worst throw their weight around without thinking or without understanding how teams work. For in medicine, as in sailing, frontline experience counts.

    Tomorrow I will pull on my gloves and get on that boat again. I will admire the competence of my 11 year old as he helms, respect my husband as he hauls the heavy mainsail, and applaud my 13 year old as she scrambles around the rigging. I will listen carefully, keep my opinions to myself (at least till after the race), distribute my (literal) weight around with care, and do everything I can to help the team reach our goal: to get us all safely round the course and to win. My knees will be bashed, my ego squelched, and my sailing management skills improved. Reality really is the best teacher.


    Cite this as: BMJ 2008;337:a1346

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