Psychiatric Bulletin (2006) 30: 353. doi: 10.1192/pb.30.9.353-a
© 2006 The Royal College of Psychiatrists
Psychiatric Bulletin (2006) 30: 353
© 2006 The Royal College of Psychiatrists
Medical management and clinical leadership
Alastair N. Palin, Consultant Psychiatrist/Clinical Director
Grampian Mental Health Services, Royal Cornhill Hospital, Aberdeen AB25
2ZH, email:
fiona.reid{at}gpct.grampian.scot.nhs.uk
Am I alone in finding a distinct irony in the publication of the first two
articles in the June issue (Psychiatric Bulletin, June 2006,
30, 201–203 and 204–206) - namely ‘Medical managers
in psychiatry - vital to the future’ and ‘Kerr/Haslam Inquiry into
sexual abuse of patients by psychiatrists’? I note in the latter paper
comments by Dr Kennedy regarding ‘consultants being "all
powerful"’ and that ‘the report challenges the absence of a
clear moral and contractual obligation for all mental health professionals to
report all such information, and the lack of an NHS system to maintain an
accessible memory bank of all such data. Will the professions fear this as a
"big brother" scenario or welcome it as an essential protection of
their patients and their credibility?’ These comments are made
immediately after an article by Griffiths & Readhead which champions the
cause of ‘medical managers’ and which sets out clearly their views
of how ‘vital’ this role is to ‘psychiatry’.
In my opinion these two articles highlight the inherent danger of the move
by the Royal College of Psychiatrists to appoint a vice-president to promote
‘medical management’ with the clear aim that we continue a
‘medical model’ of ‘medical management’ where
psychiatrists in these roles are seen as having great influence at strategic
board and other levels and indeed over other professional colleagues.
I would respectfully suggest that this move by the College reinforces the
stereotype of consultants and of medical managers being ‘all
powerful’, as highlighted by the Kerr/Haslam Inquiry. The reality is
that if we as a profession are serious about leading services into the future
and providing strategic direction, we should only be given this role if we are
able to demonstrate the ability to provide clinical leadership to all
clinicians working within mental health services. We expect psychiatrists to
work and indeed provide leadership to multidisciplinary and often multi-agency
mental health teams in a variety of settings, yet at College and other levels
we continue to promote a model of ‘medical management’ rather than
a model of clinical leadership.
My opinion is that if we are serious as a College in wishing to provide
leadership in both the development and provision of services in the
twenty-first century then we need to embrace models of clinical leadership in
which consultants engage with other professionals and accept that being a
consultant gives one no divine right to act in an all powerful, inappropriate
way. It is unacceptable for consultants’ behaviour to be challenged only
by other consultants who are ‘medical managers’. If these models
of clinical leadership are not adopted I fear the ‘failures’
identified by the Kerr/Haslam Inquiry will only be repeated in the future.
This surely is the challenge for psychiatrists interested in management roles
in 2006, and the College should be promoting a model in which psychiatrists
are selected for management roles on merit rather than simply because they are
a doctor.
