It is indeed a great pleasure to bring out the fourth edition of this book. When the first edition appeared, in 1992, management in general and medical management in particular were seen as dirty words, and clinicians who became medical managers were seen as having gone over to the dark side. Over the past quarter of a century, management by doctors has become respectable, and leadership and management skills have taken on a certain degree of prominence. There is no doubt that management and leadership skills have a degree of overlap, but by and large they are separate activities, as detailed in this book.

The entire volume has been completely revised, with many new chapters reflecting the current medical management and leadership skills. The changes in the National Health Service and resulting changes in working conditions have also meant that clinicians must be aware of competing interests and demands and yet forge a way forward in their professional lives. We very much hope that readers of all seniorities will continue to find this book useful. For early-career psychiatrists and trainees, the book will provide an introduction to the skills they need; and for more senior clinicians, it will provide an opportunity to keep up to date and continue professional development. We persist in believing that the relationship between personal skills and clinical management needs to become mainstream.

We are most grateful to our authors, who, in spite of (or perhaps because of) their busy schedules, have led from the front and delivered material which is not only a pleasure to read but also helpful and provocative in equal measure.

We thank Andrea Livingstone for her sterling support and project management of the book; her gentle and persistent style in communicating with the authors has proved to be extremely successful.

Thanks are also due to Dave Jago, Andrew Morris and the staff in the publications department of the Royal College of Psychiatrists for their help.