The Occupational Hazard Every High-Achieving Leader Needs to Know About

The workforce, if they see a very strong female leader, they'll be like "Ooh, she's a bit of a whatever." Whereas if it was a man, I don't think anyone would bat an eyelid. As a woman in a senior leadership role, you can almost expect more criticism than your male colleagues will be getting. I was in a situation where I'd wake up every morning anxious about going to work, and so I left.

it wasn't for many months after where when I reflected back on it, I realized actually I was being bullied and, when you were a junior doctor, it was acceptable to be bullied. You made a difficult decision that you had to make. Maybe you had to change the way a service was delivered.

Maybe you finally addressed that behavior in a team member that everybody else had been tiptoeing around for months, or maybe you just gave honest feedback when staying quiet would have been easier, and you got a complaint, but not from a patient or client, from a colleague. You see, you've had a complaint from a patient before.

You didn't like it, but you've grudgingly accepted that getting complaints is just part of your job, but this is different you're still beating yourself up about the complaint or the grievance or the criticism from a colleague, whether it was last month, last year, or five years ago, and it's been driving so many of your decisions ever since. Because the question it left you with wasn't about the process or the decision you made, it was about what it says about you.

What kind of person does this make me?

And one thing before we go any further, You might be hearing me talk about doctors or high achievers in leadership roles and thinking, "Well, that's not quite me."

I just want to challenge you on that because if you're the person who has to have the conversation that no one else will, or who has to make the call that someone disagrees with, or who lies awake replaying decisions you had to make, If you're that person, this is for you because this podcast episode genuinely produced an aha moment because every doctor knows that getting a GMC complaint is an occupational hazard of being a doctor.

Getting a complaint or criticism around your leadership or even an official grievance from the colleagues that you work with every day? Well, that is also an occupational hazard of being a leader, of being the senior one who has to do hard things, and it's not a sign that you were wrong for the role or that you're not good enough.

It's the price of doing something really real and really hard with people who have very real feelings about it But when you don't put this in the right category, it doesn't just hurt more and cause you more emotional distress, but it can stop you making the next right decision, Or the conversation that you really need to have just won't happen, And you'll find a reason, any reason, why you shouldn't have it.

Now my guest today is Dr. Pallavi Bradshaw. She's medical director at Medical Protection, and she's a woman who's been described as gobby. in a room where they would never have said that to a man. She's gonna say things today that I wish someone had told me far earlier. This isn't to make it easier to dismiss criticism, but it may change how you respond to it and how you carry it the next time it happens Because you are not a frog, and a complaint against you does not prove that you are.

Let's get into it Hi, I'm Dr. Pallavi Bradshaw. I'm medical director at MPS, which is the world's leading medical defense organization for doctors and dentists It's wonderful to have you on the podcast, Pallavi. We've been trying to get you on for, for a while now. You've got so much gold, so much brilliant stuff to talk about.

I wanna s- I wanna dive straight in talking about how we are trained in medicine, because medicine trains us to be really good actually a- absorbing criticism from everybody, from above and below, and but also distress from our teams, from our patients, and all that sort of thing. How does that translate into leadership?

There are probably some very good things that make us very good leaders, but I think there are some things that actually cause us to have issues when we actually have to make really difficult decisions as leaders. What, what have you seen amongst your sort of extensive experience in leadership? Absolutely. I think as doctors, we want to please everybody. We're caring, we're empathetic, and that certainly can help in terms of being a compassionate leader.

But it can also lead to problems when conflict does arise because when you're a leader, there will be conflict. There will be situations where things haven't gone quite right and you

have to hold people to account. And I think that is where the conflict comes through the nature that you have.

And myself, I know, for example that given that I have quite high emotional intelligence along with many doctors, I find it very difficult sometimes to criticize, particularly people that report into me on that sort of more junior level because you empathize so much with them and you think, "Oh gosh I remember when I was a junior doctor being criticized or shouted at by the consultants." And you would take it so personally, and it would affect me so badly.

So I do think that doctors in general, because we are often perfectionists, you know, we always want to do the best. So when we see something that hasn't gone quite right, our instinct, I think, is sometimes to protect the team, to protect the team or to try and step in and, rescue everyone, sort out the problem and then move on rather than actually address there might have been a problem and being able to then raise that with the relevant people.

And also having conflict with your peers because obviously difficult decisions have to be made, strategic decisions. Sometimes they can be quite uncomfortable because they could go against what you genuinely feel, particularly in a commercial arena. You can sometimes have that moral distress about what the best thing is to do. So I think inherently as doctors, you do have to consciously change some of the way that you behave when you, you become a leader.

And I do think that's why a lot of medical leaders can find it quite difficult. And a lot of people don't put themselves forward, I think because particularly I think in healthcare, you work together as a team with your peers, and then all of a sudden you're elevating yourself to become a medical director, where you're suddenly responsible and having to perhaps have difficult conversations with people who you worked with, you trained with.

And I think that doctors in particular can find that quite difficult. And also, I think they feel that we don't like to show off or to put ourselves forward, and it's almost like by putting yourself forward, "Oh, I think I'm better than people and I can, I can do this." it's interesting, w- a- as a doctor, if you upset somebody, if you s- upset a patient, y- you're risking a formal complaint, aren't you? You're risking somebody making a complaint against you, might go to GMC.

And obviously, you started very much the medico-legal advisor, advi- you've advised thousands and thousands of doctors when they are going through a formal complaints process that might have gone to court, that might be up against the GMC. How do you think that then translates into the fear of upsetting people, say in the commercial arena or in the leadership arena? Yeah, definitely.

I think that, as I say, you're trained to be nice to everyone, whether it's your patient or the nurses or, or your seniors. You know, particularly in that junior doctor role, you're al- you're having to really navigate lots of different stakeholders, and it's very similar to in the commercial arena, you know, your internal stakeholders, your

peers, and people around you. And as I say, I think that doctors generally will have high empathy anyway. That's one of the reasons they're probably drawn to the profession. So I, I do think that it can be really tricky to navigate that. So I think in, in medicine, we often do practice quite defensively, don't we? You know, trying to avoid the complaint at all cost. But presumably, if you do that in leadership, you're not going to be a very effective leader Absolutely.

I think we all can recall when we were working in healthcare as a doctor if you got a complaint, for example, or somebody was upset by your manner and attitude, it was, again, you would take it very personally. And particularly as a junior doctor, I think a lot of what you do is trying to appease and please lots of different stakeholders, whether that be your patient, the nurses, your seniors, your colleagues. And you can take that into, leadership in a commercial setting.

And unfortunately, as you say, if you do that and try to please everyone, you become pretty ineffective, because obviously difficult decisions have to be made. And unfortunately, you have to make them because you're ultimately responsible and accountable. And I do think particularly for women it can feel very unnatural to have to make decisions or have those conversations where you know it's going to upset somebody. How have you managed to do that? Because it, there's all this stuff.

There's a book out at the moment called The, The Courage to Be Disliked, and we do see this pattern of behavior. There's, there's sort of people pleasing, there's guilt when you upset people, the, the feeling that, like, you're in control of how somebody else is, is, is feeling, and that really stops people from having the conversations they need to have, so they're very conflict avoidant, from being able to protect their time and manage their energy because of fear of upsetting people.

is it more pronounced in women, do you think? I, I definitely think so. I think just inherently owing to societal expectations and the pressures and the way that we grow up and the nature and nurture women are given that role of

being the caregiver, somebody who's going to fix problems, and we often have that in our own family lives. So I think it's easy for us to then take that into the workplace, and we are very conscious of not wanting to upset people. And so I think it, it, it is, Personally, I f- I have found it very difficult. I'm not gonna lie. It's something that I continue to have to work on.

In fact, I recently, did a leadership assessment, and that was one of the areas which got picked up that actually I don't like having that conflict, particularly with people who are more junior to myself. I'm, I'm quite happy having those challenging conversations with my peers or people above me.

And I think we were dissecting it, and I was talking it through with the, um, assessor, and I think it is because I empathize very much with those people, probably from my own experiences of being a junior and a junior doctor. Um, And I'm really worried that I know my team's really busy this extra bit of work, I can probably do it much quicker. I know how to do it. I'll just do it. I'll not bother them because they're so busy.

And actually, paradoxically, although I think I'm thinking I'm helping them because I'm taking that work off them, I'm taking away opportunities for them to develop. So the way that now I'm trying to look at these sorts of things where I'm-- I know that I struggle with delegating because I'm… It's not so much that I'm a control freak, but I don't like putting on other people, and I think women tend to have that attitude. So I need to be seeing it as actually, no, I am helping.

I'm helping them develop, progress their careers. And so I am very conscious that actually sometimes you do have to do and have difficult conversations in the interests of the individual, help

them reflect and develop, but also for the team and for the organization. Ultimately, particularly in the role that I have, in the job that I have, we are a member, not-for-profit mutual. So I know that the difficult decisions that I might have to take in an individual case actually is for the benefit of 300, you know, 100,000 doctors and dentists across the world. So it's much easier because I then ground myself as to actually, what is the higher purpose?

And I think we can do that in healthcare when we are leading. Even though it may be a difficult decision, ultimately, what we're trying to do is for the benefit of the public and for patients. Yeah. It's really hard though, isn't it, to keep that higher purpose in front of you when you've got that distressed team member or the underperforming team member in front of you and you're feeling a huge amount of empathy towards them Oh, absolutely.

And so I think that's why and, and it's really important to have people around you, so peers that you can discuss things with, maybe have a mentor or go to a coach. Because these are the sorts of things that ultimately I do think you need sometimes external support for, to be able to reflect back and hear from somebody else actually you're doing the right thing or getting advice and tips on how to do have those difficult conversations.

But also, again, to ground you back to why do you need to do this? Actually it's for the greater good. Yeah. It's just being able to sense check that. Is this, am I being selfish and, and mean here? 'Cause I think that's what we all think underneath it. Am I being mean? Am I being unreasonable? And am I being selfish? Can I sense check that? And, and nine times out of 10, I'd say 99 times out of 100, you sense check it with someone else, they're like, " You're being actually far too nice."

that exactly what happened to me very recently. I was, I was having an email exchange with somebody and I, I, I got a little bit exercised. And, and I was still perfectly professional and polite but, but put my point across ver- forcefully. And then I sort of literally within, like, five minutes I said to my PA, "Oh no, do you think I was a bit mean?" And she's like, "No." And I was like, "Oh, okay." Not mean enough yet. I asked my other half to check an email,

uh, fairly strong email I had to send, and I, he read it, he went, "Ooh." I went, "Oh no, too much." He went, " No, too little." But Pallavi, do you think, women are genuinely treated different and ex- and there are different expectations of us when it comes to not upsetting people, when it comes to stating what we need being too assertive, all that sort of thing. Are we held to a different standard to men, and have you experienced that? absolutely. I see it all the time, I have to say.

No, absolutely. Like, I- it just frustrates me when women are described as being I've been described as being gobby. And I'm like I don't think you would ever say that to a man, would you?" That's just not… And it's because I'm assertive, and I will say what I think. And so if that was a man, they'd be like, "Oh, yes, they're very confident and articulate." So I definitely think that women are treated differently. I think unfortunately other women as well will treat other women differently.

So you'll see a strong female leader and I think even the workforce, if they see

a very strong female leader, they'll be like, "Ooh, she's a bit of a whatever." Whereas if it was a man, I don't think anyone would bat an eyelid. So I think unfortunately society has got some way to go as well in accepting strong female leaders. Margaret Thatcher, the Iron Lady she was, she was just a strong leader.

but but yeah, the way that women are described, I think is very unfair still, which is sad in 2026 So almost as a woman, as a woman in a senior leadership role, you can almost expect more criticism than your male colleagues will be getting. I, I, I think so, and I think that's probably does explain some of the difference in the way that women behave in leadership.

And perhaps we're more conscious of not wanting to upset people or trying to avoid conflict when we can, and being slightly less direct. I think as well, women tend to soften their message, whereas if a man is direct again, people are like, "Oh, yes, that's great.

Very direct, to the point." Whereas, if you're direct and to the point, you're seen as being a bit abrupt or a bit cold And when you get this criticism, how can you tell the difference between criticism that is just somebody not, not liking maybe the message that they're getting? 'Cause let's face it, if, if, if I get difficult feedback, I might potentially shoot the messenger. I don't know.

I try, I try not to, but nobody likes being told no, or being told their idea's not gonna fly, or actually being performance managed or, or having some difficult stuff pointed out or fed back.

How do you tell the difference between criticism and complaints against you that are, are warranted 'cause there's something you need to look at, or actually they're just part of the person receiving it, or that's part of this unconscious bias that people have against women, or just people not, not liking it? It's a tricky one because as I say, any criticism, whether founded or not, I think people take very personally, particularly doctors.

But I think the way that I look at it is either okay, actually is there a theme? Have other people said a similar thing? Is it isolated? And/or that's when I think having somebody to discuss it with can really help. So going to a trusted colleague or a, senior to say, "Look, what do you think about this?" and talk it through. I've been fairly lucky in actually not having too many awful comments made about me. But I, as you say, I think that it is really important that we all reflect and learn.

And so yeah. It, it… and the key is to obviously not, not to take it personally and to let it get you down. And, and if there is something to learn, then, then to do that And there is a version of some criticism that's actually about power or territory, and I, I'm assuming that the more senior you get, the higher in an organization you get, the more you're gonna come up against that. And sometimes it's treated as it's just, "I'm just gonna give you some feedback about your performance."

So how do you tell the difference, and how do you notice when it's actually about some sort of political shenanigans when maybe that shame response has already been triggered? Yeah. Again, that's ex- extremely difficult. But I think that I have to say that I, I have experienced it where I know that I've been given feedback or been told things where I know it's not come from a good place, and it is perhaps the other person feeling threatened.

So again, I think it is a, a situation where you have to try and be objective about it, look at it and go, "Okay, is there an element of truth?" Or " Is-- have other people said this to me?" Y- " Is there a theme?" And again,

going to a trusted colleague or or a peer to say, "Look, I've had this feedback. What do you think?" because otherwise, yes, it, it, it can be difficult, particularly if they are somebody who is more senior to you. Because obviously we automatically think, "Oh my God, I've got to change.

This is really awful." that's why I do think it's really important in any workplace to have a network of pe- trusted colleagues if you can to be able to have those off the record conversations just to sense check How, how do you find those people though? I think that as with anybody, like you, you can pick friends, and I think you can do that. You can pick friends and allies at work.

So you'll s- you'll be able to tell people who've got very common values to you, people that you enjoy working with. Um, and sometimes actually you don't know them, so you might want to get a completely external mentor from a different organization who will give you purely objective feedback. And the way that I've done it is either being really bold about it and emailing somebody directly or going through LinkedIn and asking them if they would be happy, to be my mentor.

or, you know, during the years you will meet various people and acquaintances and it's, that's why it's so important. I think doctors perhaps aren't as good at doing this as they should be, and it's something that I think I've accidentally done rather than purposefully, is building a large network of people that you meet along the way. You know, either you've worked with, you've met at conferences and then somebody will know somebody.

So it's really important to build that network because you're we all need support. And it's really important. You never know when one of those connections might be able to help you or you might be able to help them We often fear, approaching people and asking for help, don't we? 'Cause we think we're putting either like being a, being a pain, they're gonna say no, putting stuff on them. Do you think women are particularly good at doing that?

Do you think it's easier for men to build these, these networks? Or is it doesn't really make a difference between the genders? No, I think you're right. I think it is very much, "Oh well, why would they want to help me?" Or, "They're probably too busy. Don't wanna put upon them." and again, I think that men are probably better at looking forward about their careers and, and career planning, and so they, they can see, "Oh, actually these people could be useful in the future."

Whereas I think that a lot of women don't necessarily think like that when they're making connections at work or on LinkedIn and often will think, okay, but what have I got to offer them?" When in, actual fact, you've probably got a lot of things that you could reciprocate and offer them. Yeah, I think in, in the medical world, we really think we're over here and we don't have any transferable skills into the commercial world. Now, you transferred very successfully into the commercial world.

What did you take with you that was really, really valuable from your, from your medical training? It was the communication. I know that sounds really like cliched, but I think medics are such good communicators generally. And business is all about relationships. When you boil it down, it is all about relationships. And so if you're able to communicate well, as we have to with various people in medicine I think that puts us at a real advantage. Also Yeah, and also, again, risk management.

I think medics make such high-stake risks under such pressure that actually when it comes to business, we, we are comfortable with ambiguity and we're comfortable with taking risks. And I, I really see that as a huge advantage, over and above, potentially other professional people within commercial organizations That's really interesting.

So we're good at the risks and ambiguity and dealing with uncertainty, but on the flip side, we're not so good at dealing with personal criticism or complaints because in medicine when that happens, that's our livelihood. We could be up against the GMC, c- we could be struck off. Is that, i- is that a pattern that you've observed perhaps? Yes, I think so.

And, and i- i- you know, there's obviously fear in defensive medicine, but I do also think it's, it's not even about the worry about the regulator, it's the personal accountability. We hold ourselves up to such a high standard that actually even if there isn't a complaint, you know, if there's been an adverse event, nobody's complained, you feel awful.

You know, you're abs- I remember just feeling devastated when something bad would happen to one of my patients, and if I had contributed in any way, that was just like, "Oh my God, I was the worst doctor in the world." So,

So, I think unfortunately we probably hold ourselves to a higher level of scrutiny than, than other people. And that's why there's the phenomenon of the, the second victim in relation to adverse events where doctors may come across that they're being really arrogant because, then they're avoiding the patient or avoiding the situation, but actually it's to protect themselves because they feel so terrible about it. So how have you personally dealt with that?

I know you talked about getting mentors and, and, and stuff like that, but, the more senior you are, know, I'm sure the more you come in for criticism because people don't know you so well and you're having to make even more high-stakes decisions. There's that whole thing about don't take things personally, but that's really hard to do in my experience. It, is extremely hard to do, but as I say, I try to just keep it that what I do, why am I here? What am I doing?

I'm trying to do the best that I can. I'm not always going to get it right. And as long as I'm getting it right more often than not, then I'm probably doing an okay job.

And how, how have you managed to keep your own integrity and align with your own values when I can imagine there, like you've already said, there've been some decisions made in organizations that you maybe weren't aligned with, but because they were made higher up the, the, the, pecking order, you know, everyone has to fall in. How, how do you cope with that? 'Cause that doesn't just happen in commercial organizations, let's face it.

That happens in NHS trusts all the time, with cost-cutting and stuff, and it's this version of-- it's almost like a version of moral injury, isn't it? Where you're having to do stuff that you don't actually agree with. Yeah. I think the way that I've, I've managed to not take it to, to the point of getting so upset about it is drawing the line of where does it, where is it that it really matters?

If this is really going to harm people or patients then I will keep going and keep going and keep going until I'm able to influence and change the decisions. And I've had to learn that actually That bar's quite high. So there will be decisions I just don't like, but I'm just gonna have to suck it up. And it can-- And, and l- I'm still registered on the GMC register, so I still have that professional obligation where I see that there might be harm to patients. I have to act, and I would.

I've been lucky so far that it hasn't got to that extreme, but I am aware that actually if I'm working in an organization where there is potential for patient safety, I must escalate that, and I will escalate it, and I will do what I can. Ultimately, there will come a point where maybe you can't do any more, but at least then I feel I've done everything that I possibly could, uh, within my power rather than sort of shrug my shoulders and let it? go It's hard, isn't it?

And there'll be people that are listening to this that are, like, generally working in toxic systems where they have raised concerns and that's lead to retaliation or, had real career consequences. So, people pleasing, it's not just like, oh, it's this cognitive distortion. It's actually keeping them safe at work. What would you say to that person who who's just displaying a rational response to a really dangerous environment? This is so difficult. We have this all the time.

You can imagine when we're advising doctors that they are really worried about patient safety. And of- again, we will advise them to do what is their obligation, knowing full well that we, there could be repercussions. We're not naive.

But what we can do is try and protect them as much as possible, so for them to get as much support, professional advice as they can, whether that be from their medical defense organization or from their trade union and actually warn them, " this could go wrong but this is what you believe, this is what you need to do." And I think it is. It's just a terrible situation where the culture unfortunately is still not shifting quick enough for people to be able to raise patient

safety concerns without fear. And that's why we see scandals con- you know, recurring, and every scandal is like, "Oh my God, we can't let this happen again." And then the next scandal is, "Oh no, we can't let this happen again." And when you actually boil it down, it's more often than not about culture, uh and, and people not being able to raise concerns or not being heard when they are raising concerns.

So unfortunately, that one individual, absolutely admire those people that are ra- are able to put their head above the parapet and then face those consequences for what they genuinely believe, and it's something that as doctors, we need to all band together to to not allow those people to be isolated, and have, to be treated in that way. So I think it's a collective responsibility to, yeah, to change the culture yeah, When would you walk away? When do you know?

How can you tell if it's the right to stay in the organization and try and influence from within, because that's the only way you can change things, let's face it, and when is it right to just walk away? I think when it starts to affect your own wellbeing and your own health, I think ultimately you have to be selfish because uh, you know, it- once you start being unwell yourself or it affecting your wellbeing, you're not really going to be effective anyway.

You're gonna start having burnout problems. you're gonna be less motivated and you're better off, I think, moving yourself away from that situation and just trying to do what you, can in a different organization or somewhere else. So I think that's where the, the, the red line would be for me Have you ever been in a really toxic culture where you ended up, you tried your best and then you ended up thinking, "I just, I just need to c- I just need to walk away right here"?

And, and what was your journey about what you tried and then when you walked away? Yes, I have. And I, I practiced what I preached. I spoke to lots of people. I took counsel. I raised my concerns through the appropriate channels. And unfortunately, it wasn't getting anywhere. And then I knew if I stayed in that situation longer I was already getting very anxious.

I was in a situation where I'd wake up every morning anxious about going to work, that Sunday night dread and, and just anxious all the time, and anything would trigger me. So an email from this particular person would just cause anxiety, and I wasn't sleeping well, and I just realized that, absolutely can't do this. And so I left.

And it wasn't, I guess, for many months after where when I reflected back on it, I was like, "Why on earth did I stay even for that amount of time?" and really realized actually it I was being bullied and, and it's very difficult, I think, when you're in a situation to realize that. And I think as well from the generation of medic that I'm from, when you were a junior doctor, it was acceptable to be bullied. You were being bullied and shouted at and sworn at by your consultants and stuff.

And so I think I thought it, I saw it as a failure if I couldn't put up with it. I'm, I'm resilient. I can, I can put up with this." and and then it just got to the stage where it was affecting my wellbeing. I was, like, crying between meetings, and I was like, "No, I can't, I can't do this anymore." So how did you just not take it personally? How did you manage to separate, the person from the problem and go, "Hang on, this is the workplace culture.

It's not a defect in me." I think a lot of people just go straight to, "Oh, hell yeah." Like like you started off doing, Because I knew from before that, look, I've been performing really well to a high standard or-- and then all of a sudden this has happened.

It can't just suddenly be me that's dropped off a cliff in my ability to do my job. So I had that comfort, but also talking to other colleagues who unfortunately were going through similar views and feelings because of the toxicity of the culture. So I knew it wasn't just me, and unfortunately I'd witnessed it with other people So triangulation's quite important, isn't it, in those sorts of situations? not gossiping, but like finding out, is this happening to other people as well?

Because this is it. Often you know, bullies will do it on a one-to-one, so they'll be perfectly lovely in a meeting. So, you know, And, and so it was actually talking to other people who were having that exact same thing was happening to them. But also you know, just th- the culture generally in that, that team and department some of the conversations were, like, things you couldn't believe were being discussed in 21st century workplace, so… Sometimes it's just so obvious, right?

But actually when you're in it, it's really hard to see until you get out of it Particularly where it's perhaps a role that you really like and you don't want to leave because you're thinking actually I can just get through this. Maybe they'll move, maybe they'll leave. Maybe I'll get another role somewhere," you know? so, so yeah, all these things make you want to, to stay.

And, and again, as medics, I think in particular it's scary not having a job because we're programmed that you go to medical school, you go through, you train, da da da, and then you fall off at the end and you're a consultant and you have a job for life. And so I think one of the things that can put people off maybe leaving the NHS is that fear of not having a guaranteed job. I, I wanna come back to the bullying thing, right?

'Cause you mentioned, you mentioned the B word, and I wanna come back to the other side of things, like as a leader. Because one of the things that I'm always really worried about is that if I give feedback to somebody in my team that's a- about performance, they are going to say I'm being bullied. Now, that has never happened to me, and I hope it never will, but I think there is a, a real fear of, of, of formal complaints.

And, and we see it, we see, you know, um… In fact, I'm in a mastermind and someone put, you know, they gave some feedback to a, a new PA they have, and it, it wasn't even that bad, and they've immediately gone off sick for a month with stress. And then, there's these formal complaints going in, there's these black marks against you and all that sort of thing.

So how have you navigated the actually giving you direct and useful feedback, but without being labeled as a bully or the other person perceiving it as a bully? I know it's very important to understand we can't control how other people receive stuff. But yeah, I think it's a real minefield and, and I think it's a genuine risk for some people, isn't it? I think it is a risk. And as you say, though, the important thing is you just don't know how the other person is going to perceive it.

So regardless of how much care you put in, in trying to message, and as you say, it's sometimes not even the way that you've done it, it's just the message itself. People don't like to be told they've done something that, that wasn't quite right. And so I think it, it, it sounds really defeatist, but I think the more senior you get in an organization, the more people you end up having reporting into you. It is an occupational hazard. It's probably gonna happen.

It's a bit like we have to tell doctors these days, getting a GMC complaint is probably inevitable. It's unfortunately one of those things that you've got to live with and to feel comfortable about. And if it does happen ensure that you've got the support. Often these complaints and grievances will hopefully be seen for being frivolous or vexatious.

And although to get to that point can be awful and stressful you know, the, the stress of having to deal with a complaint or a grievance ultimately you will get to the other side, and that's why it's really important to have peer support. But yeah, I think it is a, a, an occupational hazard I think that's really useful to frame it like that.

'Cause I think for me, when I was a, a practicing GP, you know, just thinking of complaints and mistakes as occupational hazards, and your, your colleague, Dr. Eileen Weston, she gave this mantra that she says she teaches all the first-year dental students, "I'm gonna make a mistake, and some of them are gonna be serious." Like, it's going to happen. You can't avoid it.

So if you frame that, you know, you will give feedback to people and they won't like it, and they may put in a formal complaint, and that's an occupational hazard. Because what are the consequences of not giving that feed- What have you seen at a really senior level in organizations where feedback hasn't been given, where conflict hasn't occurred where people are not confronting people about stuff?

It actually has a really corrosive effect on the culture because other people in the team can see potentially that somebody's underperforming,

and if it's not addressed, they just feel completely, demotivated. So actually you're, you're ending up this one person can actually have such a negative impact on the productivity and the morale of a team. And actually you know, people will just be also thinking I can get away with anything," and, and it's… Yeah.

So I think if you're trying to build a high-performing team, you absolutely have to nip these things in the bud, because otherwise it just has such a negative impact, uh, and a ripple effect wider than you may even anticipate because you just think, "Oh it's just one team or one person." So I think it's so important as a leader to be able to see that and to call it out.

And unfortunately it can have a huge impact on the organization as a whole and how it performs on a, on a sort of a the basis financially and from a culture perspective I think in the NHS people say, "Well, if I call out that person's gonna leave and we'll be worse off than, than if they'd stayed." And I would think, "Ooh, would you actually have been worse off?" exactly. I think and I think that's right to reframe it. Actually, okay, you might be a headcount down.

Hopefully they'll be replaced by somebody more competent.

And even if they're not, actually, as, as I said, I think sometimes the morale is, is, is better when you can actually see that everybody's working towards the same goal, and that bad behavior or underperformance isn't tolerated Pallavi, if we applied the same sort of framework that, that you would apply to a doctor who's going through a sort of formal complaint from a patient, if we applied that to ourselves in our leadership in terms of getting

away from the people-pleasing, making the hard decisions, what would actually that look like in practice? Wow, that's a good question. I think it fundamentally boils down to being kind to yourself. And as I say, accepting that these things will happen. And it doesn't mean that you're a mean, nasty person. And, and just taking it as you would, that actually sometimes y- even though you feel awful, there might be something that you can learn from that complaint, things do go wrong.

We all make mistakes. Maybe we have delivered the feedback in a terrible way. We've had a bad day or we've misunderstood something. So I do think it you know, the default position I know is to beat ourselves up immediately and then want to hide. But actually, you know, to, to try and see, okay, is there anything positive that I can take from it? And it may just be simply I've had a grievance and I've got through it, and now I know what the situation is.

The next time it happens I, I'll be, I'll be more prepared. And it's the same with the doctors. When the doctors first get a complaint, it's absolutely devastating. But, being a GP in this day and age, you're going to get complaints. You're going to get aggressive abusive patients unfortunately. And it's just being resilient.

And as I say, being kind to yourself and knowing that, that actually you don't need to berate yourself, which I think is what we often will end up doing Sometimes I think we also rush to get the learning too soon before we do the, " Okay, I'm feeling crap about this," the, the be kind to yourself bit. 'Cause I'm a leader, I should just be able to take it, say, "Right, what can I learn and where have I been bad?" Actually, sometimes we just need to go and have a bit of a cry and go, "Oh.

Uh, totally. Yeah I, I absolutely agree. I do think that as I say, our default position as doctors is, "Right, gotta fix it. Okay, let's fix this," without really actually giving ourselves the time and the space to understand how it's impacted us emotionally. And I think that's one of the things that after adverse incidents people are just expected to literally just carry on. And, and I think that is something that, that is, is a bad practice within the healthcare system.

Particularly you've had a patient death, for example, that clearly is going to impact you and the team and, and time is required So there'll be some people listening to this, particularly, lead- senior leaders, and they could be male or female, that realize that they've been maybe people-pleasing all over the place, but haven't been, like, making the decisions that need to be made. And it might have cost them a bit of their team's respect, maybe their own sense of self as well.

So how would that person start to change or start to reset within the organization where they are? Yeah, I'd love to hear if you've had any experience of thinking, "Oh, yeah, yeah, I was probably too soft," and, "Let's just res- reset here and step back into that leader that I am." I think it would be really hard to be honest, and I, I have to say personally. So I started at the MPS when I was quite young. I left as a trainee ophthalmologist to, to join.

And I certainly was really conscious, even whilst I was progressing through the organization, that people still saw me as this young, junior, fresh-faced person. So it was quite difficult to try and reinvent yourself within the organization. So I did various things. Like I say, I you know, took up any opportunity to develop, to learn, to go on courses. I think the first thing is to identify the problem.

So I think if you've realized that actually you've been a bit too soft, people aren't respecting you, is A, to identify it, B, to then have a, a sort of a, a plan, a development plan as to how you're gonna address that. And sometimes it may be that actually you have to call it out and be completely open and honest with the team and be like, "Okay, look, going forward, this is the expectation that I've got from you, and this is how we're going to move move on."

Yeah. It, it is, it is quite hard to reset in a position that you are in, isn't it? Sometimes easier to go out and then come back in at a different level. But also not, not be scared of doing that, not be scared of moving around organizations 'cause you learn different things in different places, don't you?

Oh, absolutely. I mean, When I left, I'd been at MPS for 14 and a half years, and I was very comfortable. I knew what I was doing. It was just… And I loved what I was doing. But I knew in order to push myself further and to get the experience that I really needed to, to be able to add value should I come back, was to go out into a different environment. And it was scary 'cause I was like what am I doing this for?" I had a perfectly good job. You know, I knew what I was doing.

I had so many great colleagues and friends. on reflection, it was the best thing that I could have done because it built my confidence certainly that actually, yes, I can, I can be there in the big, bad world and get a good job and learn more skills and hold my own, establish myself in a new organization. so Yeah. it was, as they say, high risk, high reward. So I know that you've done a lot of research into, gender and boards and senior leadership and stuff.

What would you say to somebody who is thinking of doing a senior leadership role but not sure they can cope with the hard-nosedness that they think that is going to require, or the criticism that's gonna come their way, or the potential effects on their, on their work-life balance?

'Cause I know that is what often stops a lot of women taking up these, these senior leadership roles or, as you were saying earlier, even going to pr- to do some private medicine and, and all that sort of stuff. What would you say that, to try and help people that may have been held back by, by something like that? I think maybe there are lots of misperceptions a- about what is expected.

And I think workplaces are adapting to allow and to be a bit more welcoming for women in leadership, probably not quite as fast as we would like. So I think it… Actually hearing it from the horse's mouth, maybe speaking to somebody who's already in a leadership role to really understand what it does entail. As I say, that allows you then to make a bit of a more informed decision rather than just being s- too afraid.

And then again, maybe just taking the risk of doing it and seeing if you like it. You don't have to do it for life, and I think that's one of the things people think once, " Oh once I've committed, then that's it." people change their mind. Jobs have probation periods. it's not the end of the world if it's not for you Yeah, and we need to get over this idea in medicine that if I stop doing that job, I failed. 'Cause you can try a job and decide you don't like it, right?

Exactly. And that's, I think, where the difference is between professional people like us and people out in, in other jobs. People move jobs all the time. They change sector, they cha- and I'm like and we're sat here going, "Oh no, we can only do one thing." I, I think one of the biggest things that holds people back is this fear, like you said, of the wellbeing, the effect of their job on the wellbeing.

So is there a version of senior leadership in medicine or in commercial organizations like, like, like the one you're in that's both effective and genuinely sustainable so you can make difficult decisions, absorb pushback, and still go home and not be completely depleted by the end of the day?

Yeah. I think if you're able to do that in medicine generally, you're probably able to do it in leadership because quite frankly, the sorts of decisions that you're making, although on scale may seem bigger actually from the point of view of, And this is why since I left the NHS, I've never allowed myself to get too stressed about the decisions I'm taking because fundamentally, people aren't going to die from the decisions that I make in the commercial world.

Whereas you as a doctor, the decisions you're taking on a daily basis really do impact people's lives. So I think that's how I've been able to, to deal with it. And often you know, you're not, you're not having to make those sorts of decisions. So if, if as a doctor you are able to do that, you're gonna be able to do it in a leadership role because the stakes aren't as high from a personal perspective you know, for a, for a you know, patient at the end of your advice.

And so if someone was listening to this and they're thinking, "Right, I really need to step up. I want to do something differently," what would you, what would your main advice, your sort of three top tips be for people that are stepping into those senior leadership roles that are just a bit un- unsure? One, be brave. Two, be kind to yourself. And three, make sure that you get support from a mentor. If it's your first leadership role, I think it's so important.

And actually, I don't even think it's for, for leadership roles.

I'm, I'm a real believer that actually even doctors who s- are starting off as a new consultant or new in private practice would really value having somebody more senior to be able to talk to just even to discuss ev- cases that they found tricky or just generally in navigating, ' cause it's such a step up from being a registrar to suddenly having that responsibility of, of being a consultant And I think it is genuinely very, very difficult to overcome our people-pleasing

tendencies and and, and get the courage to be disliked on your own. It's almost impossible, isn't it? You need to have a sounding board. You need to have someone you can sense check stuff with, and, and that is something we are in control of. You can go and get a coach, and there's all sorts of free coaching offers that's going on in the NHS that are just underutilized. So like, if you have free coaching in your area, go and get, go and get the free coaching. Go find yourself a mentor.

Most people are really pleased to say, "Can I take you out for lunch once a month and chat?" Or whatever. Or get a group of friends around you just to, like, sense check stuff with. It just makes things so much easier, like you've already said. Yeah, you're sharing the burden as it were, aren't you? You just, and it, you just feel more confident. So I, I am a believer of taking those opportunities. Like you say, if there are free training courses, absolutely.

I will always seek out whatever development that I can get, particularly

if it's being put on by your employer. There's no excuse really to, to not do- I say that, obviously people are busy. But you know, if you, if you genuinely want to be looking at management or leadership, then these opportunities are really valuable Yeah.

And just because you're really good at being a doctor and you're a consultant and you're good at managing your patients, it doesn't mean that you have automatically got the skills to do that, that polit- difficult political maneuvering in, in, in board meetings and things like that. And genuinely, there are things that, skills that you can learn that can really be helpful Oh, absolutely.

And, and it is true that a lot of senior consultants just don't have those skills because I mean, we, we're not taught them. It, it's all done osmotically, it during your career. And often we have terrible role models actually w- when we were, junior doctors. So it is a skill that is separate. Clinical acumen and competence is, is totally different to being a, an effective medical leader.

I'm not saying the two are mutually exclusive, but, but it doesn't, it's not an automatic that because you're good at clinical stuff, you're going to be a good medical leader We're nearly at time now. Thank you so much. That was so insightful.

I think the thing that's really landed for me is treating this fear of being disliked or this possibility of formal complaints or people criticizing you as an occupational hazard, just like you would as a doctor treat a complaint by a patient as an, as an occupational hazard. I think that just helps depersonalize it a lot So thank you. And, if people wanted to find more about you and your work and what you do, where can they find out?

um, I'm on LinkedIn, so more than happy for, for people, um, to connect if they want to do that. And I, obviously I'm at Medical Protection, so people can get hold of me that way also Brilliant. It's been so, so brilliant talking to you, Pallavi. Thank you so much for sparing the time, and we'll speak to you soon Thanks so much