About the author
Peter Lees
Peter Lees is the Chief Executive of the UK Faculty of Medical Leadership and Management (FMLM). In 2011, he was charged by the UK medical royal colleges and the Academy of Medical Royal Colleges with leading the establishment of FMLM which became an independent charity in 2019. FMLM is the second largest medical leadership organisation worldwide with over 2,500 members. It jointly owns the journal BMJ Leader and the international leadership conference, Leaders in Healthcare. FMLM defined the first UK Leadership and management standards for medical professionals and awards fellowships against those standards.
Previously, Peter combined a career in neurosurgery with senior roles in operational management and leadership development at trust, regional and national levels and in global health. Formerly he was Medical Director, Director of Workforce and Education and Director of Leadership at NHS South Central Strategic Health Authority. He was also Senior Lecturer in Neurosurgery at the University of Southampton from 1989 to 2011.
He is a Fellow of the Royal College of Surgeons of England, a former Fellow of the Royal College of Physicians of London and a Senior Fellow of the Faculty of Medical Leadership and Management. In 2017, he was appointed Honorary Visiting Professor at The Business School, City, University of London and was awarded Honorary Fellowship of the Academy of Medical Educators in 2018. He was awarded an MBE for services to medical leadership in the Queen’s Birthday Honours List in 2021.
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We do both - hopefully
Whether we lead or manage a particular patient depends very much on that individual. As the doctor-patient relationship becomes increasingly mutualistic, one would hope that we, as doctors, are tending to lead more than manage. However, I do not believe all patients are as receptive to this as we would want. A proportion of society still gain benefit from a paternalistic doctor and will actively ask you to manage their condition. I don't believe this is purely age-related; it can also depend on the actual issue that is being asked of them. An individual patient's requirement for more paternalistic decision-making can even vary from situation to situation - they may want it for something trivial (antibiotics for middle ear infection) or very important (whether to have a further course of chemo).
In the long-term we want patient's to be stewards of their health. We all know that prevention is better than cure and usually doctors' interventions in the former are minimal. What we need to do is act as leaders, to empower patients to take stewardship for their own well-being and give them the support and tools to achieve that.
We may do both or neither
The doctor-patient relationship has undergone a radical transformation over the past decade, with a move from paternalistic dictate to a shared vision of care. Clearly to allow patients to have proper and informed ownership of their health-related decisions this transition has to be mirrored in a move from managing to leading patients.
At best, however, at the individual level we may do neither, and rather facilitate patient decision-making through the provision of balanced information and informed opinion, though management of complex care needs and leadership in overall direction of care of will likely play a part of this process. Where key leadership is needed is the broader remit of preventative medicine and public health – it is here that doctors of all specialties should play a vital role in leading the debate in both public and political arenas.