Stress and pressure to blame for doctors' poor performance

Doctors whose performance gives cause for concern are often highly committed and conscientious people, whose strengths become distorted under pressure and stress, a symposium this week on managing and motivating the medical workforce found.

The findings are based on work with 137 doctors with performance concerns who underwent behavioural assessments, including psychometric testing. Most had been referred to the National Clinical Assessment Service, the NHS body that works with doctors who have got into difficulties.

Jennifer King, chartered psychologist and managing director of Edgecumbe Consulting, which organised the symposium, said the potential behavioural "derailers" in doctors included shrewdness turning into distrust, confidence changing into arrogance, and diligence becoming perfectionism.

Medical colleagues failed to challenge difficult or unconstructive behaviours for fear of reprisals, a dislike of conflict, and the thought that "it might be me tomorrow," she said. "Doctors feel that negotiating tactics are unethical, and a dirty game that goes on in industry," she added.

The organisational culture and the wider NHS clearly had an impact on doctors’ behaviour, she said. But some distinct themes had emerged from the work to date that spanned motivation and values, personal organisation, emotional stability, flexibility, interpersonal skills, decision making and judgment, and leadership.

"Doctors are expected to show leadership but most have never been trained to do it," commented Dr King, adding that many doctors had not come into the profession knowing how to be a team player either.

But she pointed out that the NHS no longer seemed to tolerate mavericks, whose creativity was valuable. "The challenge is to maintain that creativity while steering them within restricted tramlines," she said.

Adrian Furnham, professor of psychology at University College London, commented that the NHS needed to take a more rigorous approach to recruitment to ensure appropriate placements and avoid the high costs of "getting it wrong."

Structured interviews were essential and five times more effective than unstructured interviews, he said. And he also called for "selecting out" unwanted characteristics in job applicants, rather than concentrating solely on "selecting in" desired traits and experience. "This is very important, but for a long time it has been overlooked," he said.

He also suggested that generally applicants at more junior levels tended to be put through their paces rather more than applicants at senior levels, which was ill advised.

"The best predictor of further performance is what you have done in the past, but that is rather difficult to assess at the age of 18, so we fall back on high grades at A level," said Roger Neighbour, president of the Royal College of General Practitioners.

But he suggested that an A level in the arts and humanities would help medical students become better doctors, enabling them to cope better with "the unpredictability and uncertainties of medicine" which could faze a purely scientific mind.