As a junior doctor, I moved around the country, getting trained and gaining a postgraduate research degree. The expected reward was a consultant neurologist job, working mainly 9–5, being my own boss, with the only pressure to perform coming from my peers. At first, this seemed to be the case, but distant rumblings of appraisal and job planning troubled me. The new consultant contract seemed to involve a loss of autonomy, which I felt wasn’t worth the increase in salary, and when we were all asked to vote I voted “no” instinctively. For several years, I walked past the managers’ doors to my office every day, wondering what they did. I had no occasion to speak to them, and it was only when I became Departmental Chair and had to sort out junior doctor rotas that I started to interact with the clinical service manager. I was surprised to find that she worked very hard. I began to think heretical thoughts: maybe managers were not as evil as I had thought. Their motive did not seem to be to put down the doctors, but to make the service work better. Bizarrely, I even began to enjoy solving service problems, and when I spotted a vacancy for a medical manager post, I went for it, mainly because it sounded interesting, and I needed a new challenge.

On taking up this post, one of the most noticeable changes was that I began to interact with whole groups of NHS (National Health Service) staff that previously I had rarely had anything to do with. I found …