Letters

Managers (of both sexes) would be better employed seriously considering what sorts of management styles are needed to achieve collaboration and integration, rather than this pointless obsession with macho versus touchy-feely ('A gender for change', pages 24-27, 11 June).

Scalextric (or the macho acute sector) typifies traditional reductionist understanding of medical care. The patient has been investigated down to a defined acute problem with definable acute technical or pharmacological interventions: expensive, essential, high-tech, life-saving. This is what we see on the TV all the time and is valued as the health service.

The Wendy house (or the touchy-feely community) is the patient's reality. It represents the rest of healthcare - that which is not reductionist, that which is a complex human being living in their individual circumstances. Not glamorous, not the stuff of dramatic TV series, but most of the patient's health experience.

Even if you love to play with your train set it still needs a decent house, a secure human psycho-social reality - or it is just a useless bit of high-tech knowledge.

Patients need both types of ability: one balances the other. The problem is that the less macho Wendy house (delivered by either sex, but more often a female style) is just not valued in an equal manner. That is the problem. One approach thrives on controlling a very focused technical area of defined - expensive, specialist - complexity. The other is about enabling and facilitating people to evolve care packages designed to meet individual circumstances. Between these ends of the continuum are a multitude of different blends of style. It is this ability to blend autonomously rather than revert to one or the other that is most effective in order to achieve on behalf of the patient.

Too much of either is not ideal and is not what is needed.

Bernice Baker Horsham West Sussex