Hilary Thomas On why women are not the problem

Published: 16/09/2004, Volume II4, No. 5923 Page 25

Last month, Royal College of Physicians president Professor Carol Black grabbed the headlines with her warning that the medical profession's influence could be damaged by more women becoming medics. Whether fairly or accurately represented, Professor Black has done us a favour by reminding us that medicine is still dominated by white males.

Leadership usually conjures up images of Churchill or Napoleon.

But in the NHS the quiet leaders - those we interact with on a daily basis - are more influential.What they lack in demagogic charisma they make up for in human qualities and empathy. Their influence may only be recognised in hindsight, if at all, yet they can make a huge difference to an organisation. Professor Black herself is a quiet leader.

Leadership is about motivation and change. As Eisenhower put it, it is 'the art of getting someone else to do something you want done because he wants to do it'.

Leeds University's Professor Beverley Alimo-Metcalfe has developed a model of transformational leadership which looks beyond traditional models focused on the white American male.

She interviewed 150 men and women in the NHS and local government as well as 60 doctors to give over 2,000 constructs of leadership. From this a questionnaire was developed and distributed to more than 600 organisations, yielding 3,400 responses. Among the dimensions identified were genuine concern for others, an ability to empower people to lead, being accessible, approachable and flexible, team orientated and supportive of a development culture. These may be identified as 'feminine' characteristics, although they are not the exclusive preserve of women.

The tension between work-life balance and a career in medicine is nearly as old as the profession. It is increasingly faced by men, too, as they choose to play a greater part in their children's lives. But this is a reflection of society at large - and like society, medicine must change.

I am not convinced that influence comes from sitting on late-night committees.Where is the evidence this achieves sustainable change?

The issue is not one of gender, but of balance in the profession to reflect the users of healthcare who are mostly women and children, and at the top, to reflect society in ethnicity and gender.

The lack of female cardiology professors will not matter if we replace the hierarchical medical model with an adaptable patient-focused system.A more feminised profession (and this does not exclude men) will lead quietly and effectively for the public benefit. It will influence healthcare users and encourage them to use their democratic mandate.

Perhaps we need to find a new language to celebrate the role of quiet leadership. In the words of Groucho Marx: 'Only one man in a thousand is a leader of men - the other 999 follow women.'

Professor Hilary Thomas is medical director, Royal Surrey County Hospital trust.