Published: 28/07/2005, Volume II5, No. 5966 Page 34

Medics' distrust of managers is legendary. So when trainee doctors had a chance to test their prejudices, they jumped at the chance. Sarah Trenfield and Dr Sian Jagger explain

A medical trainee's idea of a manager tends to be a shadowy figure holding clandestine meetings in musty boardrooms with the aim of thwarting clinical staff at every turn to preserve their pot of gold.

While it is a vision that is not universally held by clinicians, there is definitely a widespread wariness of managers. Born of ignorance, it is fuelled by negative press reports. So when we had the opportunity to spend a week shadowing hospital trust managers we did not quite know what to expect. What we got was an eye-opening insight into the workings of the trust at all levels, from chief executive down to the coalface.

The week was divided into sessions spent in various directorates with their corresponding managers. Although routine matters for our hosts, the world of hospital management was foreign to us, with its own language and agenda.

In human resources, we discussed recruitment and retention of staff, disciplinary issues and how national initiatives are likely to impact at a local level. In finance, we learnt how the trust engages in negotiations with local primary care trusts to secure service contracts, and how problems can arise.

Attending a trust board meeting resembled a scene from a Tom Sharpe novel. In one corner was the 30-strong local action group, led by an amateur expert in saving hospitals deemed fit for closure. She cut a formidable figure and wasted no opportunity in making her presence felt. In the other corner was the hospital board. Judging from the battleweary looks on their faces, they had faced one another many times before.

It was a reminder of the difficulties in conducting effective meetings in a public forum - and that public consultation is now a fact of life in the modern health service.

As onlookers based at another site, we could appreciate the clinical and practical argument for hospital closure, perhaps because we did not share the strong emotional attachment felt by some colleagues and their overriding desire to save historical bricks and mortar.

While shadowing, we were able to question managers on every topic we could think of - and then some. We encountered enthusiasm and commitment from managers who were striving to achieve a first-class clinical service that met national targets and also provided the best environment in which clinicians could practise quality medicine.

It was a very positive experience, and one that will benefit us in our future roles.

Why has there been such tension between doctors and managers in the NHS? Undoubtedly, we are fundamentally different animals. However, we share high levels of commitment, long hours, specialisation, and effective interpersonal skills.

Historically, doctors have enjoyed the benefit of being members of a profession generally held in high public esteem. It is based on strong scientific foundations, has the support of professional bodies and enjoys access to comprehensive, professional peer-reviewed information.

Unfortunately, we often lack the objectivity to step back and think about the requirements of the organisation as a whole over the needs of the individual.

Doctors need to embrace the managerial qualities that will benefit not just themselves in their clinical 'cell' but also that of the wider organism: leadership, team working, fiscal prudence, political savvy and strategic thinking.

Doctor-manager relationships would benefit if managers acquired a greater insight into the issues facing doctors: the pressure of providing an excellent service within the constraints of the target-driven 21st century NHS, the limitations imposed by staffing, equipment, facilities and pharmaceutical choice.

Perhaps a quid pro quo clinical work experience week might be in order? If we could put ourselves in each others' shoes, even for a few days, it would facilitate better understanding and a healthier working relationship.

The insight gained on the management experience course fills us with enthusiasm for taking on a future role that will involve interaction with managers.

Contrary to what some people believe, we are all striving towards the same goal of providing the best care for our patients.

Sarah Trenfield is clinical fellow in the department of anaesthesia and Dr Sian Jagger is a consultant anaesthetist at Royal Brompton Hospital, London.