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Out of darkness and into enlightenment
  1. Peter Lees1,
  2. Stephen H Powis2,3
  1. 1 Faculty of Medical Leadership and Management, London, UK
  2. 2 Royal Free London NHS Foundation Trust, London, UK
  3. 3 Department of Nephrology, University College London, London, UK
  1. Correspondence to Dr Peter Lees, Faculty of Medical Leadership and Management, London NW1 4LB, UK; peter.lees{at}

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We have both had the privilege of spending a significant part of our careers in medical leadership and management. We have also been privileged to have had fascinating and rewarding careers as clinicians which have allowed us to contrast the two worlds—with some authority we can say that neither is for the faint-hearted!

The immediacy of the outcomes of clinical care contrasts with the slower burn of the outcomes of managerial activities. The complex problems of clinical medicine compare with the complex, ‘wicked’ problems of leadership—for both, the wise seek consensus when time and circumstance allow, but in leadership issues there is probably less precedent to call on and certainly far less evidence. Both worlds combine when clinicians increasingly face the tension of having to consider not just the patient in front of them but the population around them. Within that tension lies a significant driver for the clinician leader—namely the size of the canvas. As a …

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