You might think as a doctor I was used to breaking bad news. Yet it seems that there are areas that have the ability to still challenge me. Weak spots in the skill set I have slowly build up from many years of supporting patients and families come to terms with life altering news.

These past weeks I have had to disappoint a number of colleagues. Letting people know that they have failed to get roles is never easy. Updating a colleague, sometimes with more seniority than oneself is very tricky. I’ve realised a few things during this process. Firstly, I don’t like the feeling of authority that this seems to give me. It is just a feeling. The decision to appoint into medical managerial roles has been made not by me on a whim but after an open application process with a panel interview and consensus. Indeed, the panel had a broad range of  representation: nursing, management and a diverse ethnic makeup. I’ve also had to think hard about process. Firstly nurturing and nudging people into being brave enough to send in an expression of interest. Within the interview itself, the anguish of choosing between excellent candidates, whom I know well made me think hard about how to extract the panel feedback. I decided in advance of the interviews to ask the panel to rank the candidates and then asked the panel to share the outcome of this, starting with the panellist who knew the candidates least well, ending with me so my views did not bias the panel.

I also anguished over the how to break the bad news to the candidates and sought advice from colleagues. I even spoke to our staff psychologist who I have worked with to support teams and knows some of the individuals involved. She helped me to extract some core thoughts: being clear about the outcome and the competitive nature of the process, explaining why the person had not succeeded at interview and leaving open and indeed then creating further opportunities to mull over together other leadership routes. I think the latter was particularly useful as it meant there did not need to be a hard stop to the conversation, rather a gentle petering of the first conversation with the potential for a further one. The discussion with the psychologist also let me understand that it was ok to feedback to candidates that I was finding the breaking bad news hard and to explain why. I think this enabled me to break the news with humility, honesty and emotion not just to report in an automaton like manner, which I truly hope helped the unsuccessful candidates.

I think the reason it felt so hard was that there are few senior medical management roles and for someone who did not get the role but truly wanted to pursue this route, it must have felt like a door was creaking shut; however much I tried to offer imaginative alternative routes to roles. Maybe it was just me wrongly imagining how it might have felt.

This was made harder because some of those failing to get roles had been occupying versions of these roles and so, my anguish for them was compounded by a desperate desire to help them leave roles with dignity. Medical colleagues are many things but few truly have a skin thick enough to cope with weathering a potential loss of face. And whilst I would like to say we medics are a totally supportive gossip free group, I fear that may not quite or always be true when it comes to how we speak or act towards each other.

What have I leant?

• That thinking through the process is crucial to finding a way through a maze of complicated emotional or hierarchical structures.
• That saying “No, you can’t”, doesn’t sit well with the joy I felt personally and that was reflected back to me by successful candidates.
• That leading is hard in ways that keep revealing themselves to me.
• And, that part of what keeps me compelled to step up to the challenge is finding ways through these complex emotional situations and doing so by drawing on my experience, my empathy and the skills and knowledge of others.

Magical Meander

Magical meander is an anonymous blog written by a medical manager working in the NHS and published every six weeks on BMJ Leader Blog.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.