The doctor–manager relationship†

The different cultures of doctors and managers and the impact of these on their working relationships are described. A historical resumé tracks organisational change, the evolving nature of the relationship and the stresses it engenders. The phenomenon of scapegoating and an approach to managing risk is explored. Vignettes describing familiar problems, with suggested strategies for analysing them and resolving difficulties, are presented. Antony Garelick is Associate Dean of MedNet and a consultant psychiatrist in psychotherapy for the Tavistock and Portman and North East London Mental Health Trusts (Tavistock Clinic, 120 Belsize Lane, London NW3 5BA, UK. E-mail: [email protected]). Leonard Fagin is a consultant psychiatrist and Clinical Director of the North East London Mental Health Trust. †For a commentary on this article see pp. 250–252, this issue. Box 1 The worlds of the doctor and the manager The doctor The manager Focused on the individual patient Focused on population groups and government agenda Will not be primarily concerned with costs Focused on treatment efficiently delivered within allocated resources Has face-to-face contact with patients Rarely meets patients or families and families Expected to solve all presenting problems Has to choose which problems to tackle Has learnt to be independent and competitive Expects to share responsibility with others Trained to emphasise the scientific approach Has to remember political factors and human motivations Expects problems to have solutions Expects to have to tolerate many insoluble problems Expects to stay with the same trust for Has to move to gain promotion or because of whole career and has job security redundancy High social status and professional freedom Medium social status and subject to bosses