ABSTRACT

Leadership ... by his dignity and his calm self-control in the face of unexpected difficulties he [the physician] checks the excitement of anxious relatives and friends.

(Hippocrates) Good communication, especially when the relative is demoralized, depressed or frightened, should sometimes have a strong element of leader­ship in it. The qualities needed are very similar to those needed by a good leader in a non-medical emergency or crisis. Qualities such as staying calm, showing confidence and being decisive may all need to be clearly communi­cated to an anxious relative. Perhaps not in exactly the same way as to the patient, but in a very similar way.Strong leadership, or at least the open mention of it, is rather out of fashion at the moment. Sometimes there is a reluctance - even a refusal - to lead. The idea is that patients (and to a greater or less extent relatives) must just be given the facts and then weigh up the pros and cons for themselves. This may sometimes be right, but in practice the perceived ethical and legal advantages are often outweighed by serious disadvantages.Many patients and relatives are ambivalent. Sometimes they like humil­ity, a doctor who honestly says that he doesn’t know. But at other times, often depending on how frightening or serious the situation, these same people - whether patients or relatives - may desperately need from a doc­tor or nurse the qualities of a good leader, with a measure of confidence and sureness about what needs to be done. After all, to make the point again, in any crisis this is what we all need from a partner or friend. Someone who is not just sympathetic, but who is firm and decisive and who gives us strength.Experience helps. To have dealt with similar situations gives confi­dence. But the truth is that doctors always have to try and act calmly and confidently. Though their real feelings may be strongly tinged with bewil­derment and doubt, all men and women acting as leaders (or as those who have to make quick, firm decisions, whether or not you choose to call it

leadership) have to try not to show this.One kind of leadership is to be very firm, saying little, yet giving con­fidence - the ‘strong and silent’ approach. This is something that some health workers carry off very successfully, but which others can’t quite get away with. They don’t have the personality for it. For them a different approach may be needed, including - whenever there is time for it - explanation and justification at every stage.