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Partha Kar: Losing one’s faith in leaders

BMJ 2021; 372 doi: (Published 17 February 2021) Cite this as: BMJ 2021;372:n424

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  1. Partha Kar, consultant in diabetes and endocrinology
  1. Portsmouth Hospitals NHS Trust
  1. drparthakar{at}
    Follow Partha on Twitter: @parthaskar

It’s awkward—really awkward—to look back at something you’ve written and realise it hasn’t aged well. I’ve reached the point where I need to reassess an issue I wrote about for The BMJ in March 2020, where I argued that “we must keep faith in our experts.”1

Spending time on wards full of patients with covid-19 in recent weeks has made things hit home. I’ve worked with teams who are tired, gritting their teeth, and battling exhaustion, looking after so many when the spirit of the first wave has long passed.

Among all the suffering, some patients stand out. Walking into side rooms or closed bays, I’ve seen sheer fright in the eyes of those who teetered on the edge—those patients’ imploring looks as oxygen saturations were held just high enough with high flow oxygen, their eyes asking, “I will be OK, won’t I?”

With no families around, they were looking for reassurance from the doctor at the end of the bed. And that reassurance is so difficult to give. I couldn’t simply smile and say, “Don’t worry, you’ll be fine.” Behind the mask, behind the face shield, through the gloves, you try to reassure, but the heart still aches. I’ve seen death plenty of times in my career. But it just feels so tough, almost a year into the pandemic.

All of this made me reconsider that column from last March. I had asked people to stop sniping and to give our leaders—Whitty, Vallance, Van-Tam, et al—the space and time to operate, shape plans, and steer the nation out of choppy waters. Was I wrong to have faith at that stage? It’s my personal philosophy to give anyone stepping into a demanding role enough time to help us all; the question is what you use as a barometer of success. On reflection, I have no regret—just a sense of one’s heroes failing, which perhaps leaves a more bitter taste.

I placed my faith in our clinical leaders to stick by the science, stand up to politicians, go public when necessary, and do what it took to protect lives. Fast forward 11 months, and my faith is palpably lost. We have more than 112 000 deaths, alongside the pandemic’s impact on society, children, cancer care, and other services.

Many people will disagree with my view. Some will say that sometimes you have to stay on board for the greater good. But I believe that, at some stage, that point is passed. With death rates as they are, at what point do we as senior clinicians say, “I’m done. No one’s listening to my advice, and that’s why lives are being lost”?

What, exactly, has gone right so far, apart from vaccine delivery by primary care? We’ve seen the development of a contagious variant, the opening up over Christmas, a lack of any cohesive strategy to support people from ethnic minority backgrounds, and a vaccine strategy that may work—yet wrapped around a sense of hope rather than science. When it was known that loosening restrictions over Christmas would lead to a huge surge in deaths, where does the responsibility lie? When do we acknowledge that being silent over these failings makes us complicit?

I’m frustrated and tired. I’m hurt by my own loss of faith, when I’d placed so much trust in leaders. We’ve been brought to this position by an out of control pandemic, itself brought on by the same people who failed to influence politicians to do the right thing: close borders, lock down early, forget Christmas for a year.

To me, leadership isn’t defined by how nice or popular you are. It’s defined by outcomes. That’s how I judge my own successes and failures. In this pandemic—if death and collateral damage are the barometers, as they should be—the leadership teams have failed us all.