Leadership with a little 'L'

“The thing that gets me,” said the doctor sitting next to me “is that when I hear you talking about leadership and management and all that, well, I’m just glad I’m not one of those people.”

“You mean, those who are interested in leadership, management….and all that?” I asked.

“Yeah,” he replied. “I’m just keen to see patients and get to know my stuff…to be good at the clinical side. I’m not really interested in the management things. But I’m glad there are folk like you, though…saves me having to worry about it! Now – can I ask you about that lady I just saw in Cubicle 14?”

Our conversation moved away from the issue of leadership and into familiar waters – the pathological basis of that raised JVP, the issue of her candesartan dose. Within ten minutes we had dealt with these matters, and the conversation lulled for a moment.

“So what’s the plan for that lady now?” I asked the FY2 who had been talking to me.

“Well…that’s just it. By chance it’s the same RMO on call today who discharged this lady earlier this week. He says from what I’ve told him, there’s not much change. In fact he was wondering why I’d referred her again.”

“Hmmm…he’s got a point though, hasn’t he?” I suggested.

“Has he?” came the startled reply.” It’s a no-brainer! She’s only just been discharged. Nothing’s improved, so she’s come back again. What else would I do?”

And so began a digression into the nuances of a very old lady arriving into the Emergency Department by ambulance at 4pm on a Friday afternoon. What had been the advice upon discharge? Which relatives or carers were in the loop? What had been going on at the nursing home to trigger the 999 call today? What did this lady’s GP make of it all? What would the Acute Medical Unit have to offer this frail old patient?

Before too long, we – or rather my colleague – had arrived at an altogether different action plan.

“I’m going to start by calling the home manager and seeing how things have been going since yesterday morning. And I’ll try and catch the GP too – I know it’s evening surgery now but if I mention what I’m calling about I’m sure they’ll get back to me afterwards. And is it worth me phoning the rapid response mobility team to come and look at her walking frame? It says on the home records she should have a frame, but it’s a stick she’s come with in the ambulance.”

Our paths parted at that point, his taking him back to Cubicle 14 and a series of telephone calls, mine to other parts of the Department to get a handle on our 3 hour queue in the minor injury area and the reality of four beds in surgery in which to squeeze seven referrals in the past hour. About half an hour later, we ended up sitting side by side at the main desk writing up our notes.

“How have you got on?” I asked.

“Fine” he said. “I managed to get through to the home and to the GP. Turns out there had been an agency nurse on this afternoon who panicked when she saw the lady trying to walk by herself, gave her a stick, but she wobbled and fell back on to the bed – the patient not the nurse! – and that’s what set it all off.”

“So she’s going back to the home?”

“Yeah – and the GP will arrange a visit from the Out of Hours team tomorrow. Thanks for the advice about her.”

“You know,” I said to my colleague as we both wrote away “that all that you’ve done with that case is lead and manage, really…you knew the clinical bits; that much was obvious. But you’ve actually led a package of care for her – you’ve managed the situation and led a team of people that you’ve never met…the GP, the home, the mobility team…and sorted it out.”

“Yes…I suppose I have…” considered the F2. “…sort of leadership with a little ‘L’ really.”

I could only agree. Like all good things, leadership comes in small packages.