Guest blog by Dr Shriti Pattani OBE, SOM Past President
I never set out to be a leader. In fact, when I was first asked to speak at a leadership event, my instinctive response was: “But I don’t have any formal leadership qualifications.” The reply I got back stayed with me: “You have several leadership roles running in parallel – that makes you a leader.” That moment made me reflect on my own journey, and what leadership really looks like in occupational medicine.
Leadership does not begin with a title
My first formal leadership role came early – transitioning from being an occupational health trainee to becoming Clinical Director in a large London NHS trust. Overnight, I moved from being a peer to leading people I had trained alongside and managing colleagues more senior than me. At an organisational level, I would sit in meetings with senior colleagues shaping strategy, only to see the same individuals later in my clinic as my ‘clients', where the dynamic was entirely different. Learning to navigate those shifting roles was an early and important leadership lesson. What struck me most was the assumption that becoming a consultant meant I had automatically 'graduated' into leadership. Like many clinicians, I had received little preparation for this shift. I was quietly spoken, avoided confrontation, and valued relationships. I had ideas for improvement – introducing clearer processes, using data better, questioning whether some contracts were sustainable – but quickly learned that change alters dynamics, and not everyone welcomes it.
Looking back, I realise this is where leadership really began: navigating uncertainty, learning how to be heard without changing who I was, and discovering that leadership is less about authority and more about trust.
My four Cs of leadership
Over time, I came to define my own framework – not from a textbook, but from experience. I call it my four Cs: competence, confidence, compassion… and cucumber.
Competence matters. You need to understand your service, your people, and your system.
Confidence matters too – because if you do not back yourself, it is hard to expect others to do so.
But compassion has been the constant thread throughout my career. Leadership is about people, not processes. Listening, being present, having 'five minutes' when it matters – these are not soft skills; they are essential ones.
And cucumber? That is my reminder to stay cool, calm, and collected – especially when things feel overwhelming.
Leadership is lived alongside life
Leadership does not happen in isolation from the rest of life. Alongside my early leadership roles, I was navigating marriage, children, finances, and later, caring for sick parents. Like many of you, I blurred boundaries, worked evenings and weekends, and told myself I would rest later. I did not always get this right.
What I have learned – sometimes the hard way – is that leadership is a marathon, not a sprint. You are not just responsible for the job; you are responsible for the people doing the job, and that includes yourself.
Finding mentors helped me enormously. We expect supervision in many professions yet often deny it to ourselves when stepping into leadership. Having a space to reflect, challenge your thinking, and regain perspective can be transformational.
When values are tested
One of the hardest moments in my career came when organisational change compromised my ability to lead in line with my values. A poorly planned merger, escalating pressures, and diminishing resources meant quality and compassion were being eroded. I reached a point where I could no longer lead in a way that felt safe or ethical.
Choosing to step away was one of the most difficult decisions I have made – but also one of the most important. Leadership is not about endurance at any cost. Sometimes it is about recognising when staying would mean losing yourself.
That experience deepened my understanding of compassionate leadership: having difficult conversations with humanity, setting boundaries, and knowing when to walk away.
What I wish I had known earlier
Leadership can be lonely. You will make decisions others do not see the full context for. You will carry responsibility quietly. And when things go well, it is your team who deserve the credit; when they do not, the accountability sits with you. But leadership is also deeply rewarding. It sharpens you, stretches you, and allows you to shape systems for the better – particularly in occupational health, where our impact is often unseen but profound.
A message for the next generation
If you are early in your career and wondering whether leadership is for you, my message is simple: leadership does not require you to change who you are.
Occupational health professionals already juggle multiple perspectives – employer, employee, clinician, system. You already understand risk, relationships, and balance. These are leadership skills. Be curious. Find mentors. Learn the language of the system, but do not lose your values. And remember, leadership is not about doing everything yourself – it is about enabling others to thrive. You do not need permission to lead. You just need to begin.