Doctors and managers : Agreeing objectives could help doctors and managers work well together

Editor—Whether this cry is that of a beleaguered health service manager or a consultant who feels that his or her powers have been eroded a little more, the lack of understanding between managers and doctors is manifest.1-1 Why is this so? The degrees of certainty and agreement in medicine are often perceived to be greater than they are. Although evidence based medicine informs us that treating hypertension is a good thing, that same evidence will remind us that it is impossible for a doctor to discern whether the patient sat in front of them will be the 1 in 500 people to benefit from the antihypertensive drug on offer. By the time patients have pondered the side effects and remembered something that they were told in the pub it is almost a matter of chance whether they will take the drug—and there are many more barriers to prescribing bendrofluazide.1-2 Yet, patients with hypertension would benefit from the input of a manager to support the interaction between patient and healthcare system, without which the system will fail. We argue that the reason these tensions exist lies in the opposing world views held by both groups: clinicians see their work as an art to be expressed in the unique care afforded to each patient, and as such intrinsically immune to the homogenisation of management. But managers' world view consists of precisely that—the broad thrusts of commissioning, audit, and risk management. Both are right. There is depth and mystery in much of medicine, but to stop there would be inadequate. Sense is needed to cope, assure, and improve. Managers need to understand that the process of dividing into manageable parts has real dangers—a loss of meaning. Doctors meanwhile need to understand that through such division, their complex art can be more easily understood. World views can be different and still be complementary. We commend the notion of professional permeability. Let ideas spread by osmosis between the groups by seeking out the other's perspective. What about doctors and managers sharing a community of practice? No—they wouldn't understand.