Intended for healthcare professionals


Doctors and managers: a problem without a solution?

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:609

No, a constructive dialogue is emerging

  1. Nigel Edwards, policy director (,
  2. Martin Marshall, professor of general practice,
  3. Alastair McLellan, editor,
  4. Kamran Abbasi, deputy editor
  1. NHS Confederation, London SW1E 5ER
  2. National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL
  3. Health Service Journal, London NW1 7EJ
  4. BMJ

    In preparing this theme issue on doctors and managers we were offered many sophisticated descriptions of the origin and nature of the tension between doctors and managers but fewer credible solutions. The fundamental problem is a paradox between calls for a common set of values and the need to recognise that doctors and managers do and should think differently. If managers suddenly became preoccupied with the needs of an individual patient, irrespective of the consequences for others or for their budget, then the health system would collapse. If doctors decided that their principal concern was to ensure the smooth running of the system and the delivery of policy irrespective of the consequences for the patient in front of them, then both the quality of care and public support would collapse. Doctors worry about patient outcomes. Managers worry about patient experience (which includes outcomes, but only as part of a mix to be met out of finite resources). Patients are, again, best served by a tension between the two.

    Admitting that this paradox …

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