As good as the next man

Frustrated by the failings of the NHS, Anthony Grabham entered the “macho” culture of medical politics and quickly became an influential leader, politician, and surgeon. Barbara Castle, a former UK health secretary, called Grabham “the best negotiator I ever dealt with.” Quite a compliment, although tempered by her observation that he was also greedy and arrogant. Richard Smith describes in his obituary this week (doi:10.1136/bmj.h502) how Grabham went on to play a pivotal role as chair of the BMA committee that oversaw the development of the BMJ Publishing Group and The BMJ. When Grabham entered The BMJ’s offices for his regular meetings with Smith, then editor in chief, he did so with patrician authority, unshakable support for the journal, and an occasional smile.

Grabham isn’t known for running a hospital. Indeed, why would a consultant think of going into hospital management? The reality of clinician leadership, writes Richard Vize (doi:10.1136/bmj.h922), is that the NHS is keen to encourage more senior doctors into management, but few make the leap. Clinician leaders can improve quality. A study by the US Institute for the Study of Labor points to a strong positive association between the quality of a hospital and whether the chief executive was a physician. Other research indicates that the effect of clinically qualified managers may work through a better understanding of the process of care delivery, improving communication and credibility among clinical staff.

Vize’s feature quotes Mark Newbold, a doctor who recently resigned as a hospital chief executive. Newbold explains that the NHS managerial style and culture is unsuited to doctors, with its “harsh, often bullying, performance culture.” A first step, he says, is to provide strong and explicit support for new chief executives, so that doctors do not feel isolated and at risk of sanction for failing to solve problems that are long standing and that have roots beyond a single institution.

Another reason for doctors to be reluctant to become chief executives is risk of censure by the General Medical Council. The experience of being investigated by the GMC is stressful, detrimental to health, and professionally damaging. A recent, wide ranging report by the GMC on suicide among doctors under fitness to practise review proposes extensive changes to its processes, including greater emphasis on wellbeing. Keith Hawton (doi:10.1136/bmj.h813) identifies a two year pilot of a national support service for doctors as the most radical recommendation in the GMC’s report.

“Medicine is a high demand, high responsibility, high risk job,” confirms Amanda Howe in her editorial (doi:10.1136/bmj.h791) accompanying new research on doctors’ divorce rates. The study, by Ly and colleagues (doi:10.1136/bmj.h706), finds that US doctors have a lower rate of divorce than other health professionals have but that divorce is more likely among female doctors than male doctors, especially women who work long hours. Howe calls for an important professional conversation about risk factors for divorce and their impact on doctors’ lives. The “macho” culture that Grabham thrived in is less supportive of women who need to prove themselves “as good as the next man.”