Abstract
In her Presidential Address [1] Janice Wilson uses the flight of the wild goose as a metaphor for Psychiatry. It is wonderfully evocative, but the implicit organisational dynamics are a worry if applied to our profession. The goose formation is one in which the leading bird alone decides where they are going and the rest mindlessly follow the path of least (wind) resistance. This unfortunately chosen metaphor is precisely the opposite of what Dr Wilson says is the aim of leadership, that is, to empower those who are led. Mindlessly following the leader is not an image of professionals who are individually empowered to advise those who consult them and who are individually responsible for the results of their professional advice. The goose metaphor weakens our claim to be medical specialists bound by medical ethics.
Medical Ethics arose and are necessary as formal rules to deal with the inevitable conflicts between the patient's interest and the doctor's interest and to settle them in the patient's favour. If doctors were to mindlessly follow a path determined by a leader they would need to abandon their right and ethical duty to assess and advise each patient as a unique biopsychosocial individual. A good example of this unfortunate trend is the Medicare funding limit of 50 sessions. On the Health Department's own admission this was decided not on any clinical grounds but as a ‘price signal’. Cost cutting took precedence over patients' interests and I believe our collective state of mind reflected in the goose metaphor has blinded us to the serious ethical problem that this has created.
A second matter in Dr Wilson's address with which I would take issue is the notion that leadership in psychiatry can be divorced from clinical leadership. Psychiatrists must acquire a specific body of knowledge upon which they base the advice given to members of the public who consult them. The public rightly expect each individual practitioner to master and maintain the relevant body of knowledge. In psychiatry, our knowledge comes from two sources. One is academic, but that alone is not enough. Prolonged clinical supervision and then on-going, peer-reviewed clinical work with patients for whom the individual doctor is responsible is necessary to master and maintain skills in our profession. This is the only way for psychiatrists to keep their feet on the ground about the realities of practice. Would you fly in a jumbo jet piloted by someone who was a master of the theories of aerodynamics and jet propulsion, but who had not actually flown an aeroplane for years, if at all? I believe that any attempt to become leaders and/or consultants without being known and respected as clinical practitioners as well will only damage our credibility as medical practitioners further and perhaps even fatally.