I suppose many people might suggest that a year as mess president at Addenbrooke's Hospital in Cambridge, and then two blocks of 3 years as lead clinician for neurology in Edinburgh, represented the perfect preparation for elevation to the dizzy heights of a clinical director's post. They'd probably be right; but not because these lower level posts trained and equipped me for the more senior role, rather because these more lowly pastimes enforced a delay which prevented me from taking on the ‘bigger position’ until my late forties. Any sooner would probably have been a mistake, in that youthful exuberance would have made me want perfection and smooth efficiency in everything, whereas my more mellow view now accepts that systems of management have good and bad aspects, with quirks and idiosyncrasies, and sometimes inevitable inefficiency simply because of the leviathan nature of the animal that we're trying to manage.

I wasn't forced into the post. But several colleagues were positively gushing in their encouragement to ‘go for it’. Presumably implying that they actually wanted me to do the job but of course raising the possibility either that they were terrified they would end up being invited to do it themselves, or worse still, that a less appealing candidate would step forward. So, as lone applicant for the role, it was difficult to know what could go wrong in the interview, which was predictably tame and warm in tone, with a very prompt announcement of the positive result.

I have always thought there is a mindset issue when it comes to being any sort of medical manager: the key philosophical question being whether you will become ‘a doctor among managers’ or instead will develop into a ‘manager among doctors’. There is surely an analogy with the move from senior registrar (or …