The fox, as the old story goes, knows many things. She’s a generalist. Even when her skill set is only an inch deep, it’s still a mile wide. She can see the other side of the argument.
She can think outside the box. She’s a holistic problem solver. She’s a fantastic collaborator. She can strike an empathetic posture. Just ask the hens in the henhouse.
The hedgehog, on the other hand, knows one thing — but he knows it well. He’s a specialist. He didn’t get to the top of his game by accident.
He spent years eschewing other pursuits to refine his craft. He’s a loner. He doesn’t believe that there even is another way of seeing things. He’s prickly — in more ways than one.
What kind of doctor are you — a fox or a hedgehog? And what kind of doctor do your patients want you to be?
Some patients might sincerely believe that they’d prefer their physician to be a hedgehog. They want the doctor with the most knowledge about their diagnosis and they could care less if he plays well with others. An individualistic streak, even a touch of misanthropy, might be seen as a badge of honor.
These patients harbor an antiquated view about how modern medicine works. Medicine, at least these days, is a team sport. So many of us work in big hospital systems where the pursuit of good patient outcomes requires that you integrate — and ingratiate — yourself into an ever-shifting array of other MDs, nurses, administrators and other health professionals, each with his or her own expertise, values and viewpoints.
No one exists in a silo. And those of us who work in smaller settings need to provide for the needs of a variety of complicated patients, often more or less by ourselves. Would you trust a hedgehog to do any of that?
And yet, paradoxically, the forces of modern medicine are slyly nudging young doctors towards the hedgehog mindset. More and more young doctors are spending years and years pursuing hyper-specialized fellowships. And MDs with those narrow skill sets are taking home a bigger piece of the pie.
The joke among general surgery residents is that, at least in urban areas, the job they’re training for — general surgeon — barely exists anymore.
But all is not lost. In medicine, being a fox is as much about owning a breadth of expertise as it is about cultivating an open and collaborative mindset. We always talk about how physicians must commit to a lifetime of learning.
That ethos is unassailable, but it needs to extend beyond the narrow pursuit of specialized knowledge and encompass listening to, empathizing with and, most importantly, learning from our partners and teammates all around the hospital. The reality is that that’s the only way to effectively leverage our resources and achieve great outcomes for our patients.
That’s yet another thing that the fox knows.