What does all of this mean? It means too much individual autonomy. One of us usually offers a joke to point this out to doctors. We need to offer gentle jokes as a way to bypass our defensiveness–because as physicians we highly prize our individual autonomy. Someone saying anything negative about this autonomy can appear as though they are betraying the tribe. Here is the joke:

If a pilot was given the kind of autonomy surgeons have had historically—then they could decide to fly to Brazil to visit their girlfriend on way to taking a plane full of people from Boston to SF, because “hey, I’m the captain of this plane, I go where I want to go”.

That is the extreme of individual autonomy, which becomes tyranny in its most extreme form.

Secrets and Elephants

Too many secrets are often being held among those working in contemporary health care systems. Secrets are a key tool of Patriarchy/ Vertical Hierarchy. They have a purpose, yet if over-done, they become a source of POWER over others. This is how cults get their power, through secrets. You must have secrets to keep the Patriarch/ Cult Leader in power, because they are just as flawed as everyone else, yet making them perfect serves a purpose for the hierarchy.  Secrets are not intrinsically bad—yet when over-used they can amplify power and distort things. When we retain secrets and fail to share information with other members of our team or organization, we are likely to fail in our attempt to fully appreciate what is happening all around us.

Given the challenge of secrecy, we propose that we consider a more in-depth dive into individual vs team culture in healthcare with a complexity lens. Why does navigating complexity require teamwork?  It is become the issues being confront are often not straight-forward easily addressed problems. Rather, as we mentioned in our first essay (Fish and Bergquist, 2020), the more deeply we dig into an issue we find that it is a multidimensional problem. At an even deeper level we will find underlying dilemmas, polarities and mystery.

When digging deeper, we find that it takes “more minds” to have full picture of what is going on. As in the old Sufi parable, each of blind men touch only part of the elephant and believe that they “know” all of the parameters of the object they are touching. Only when they come together and “compare notes” do they discover that they are touching an elephant.  There is a parallel African proverb: “it takes a village to eat the elephant”. North Americans might say “a journey across the Grand Canyon begins with a single step. A leap of faith at the edge ends at the bottom, not the other side” We will not navigate complexity well in healthcare until we shift toward teamwork in a meaningful way.

Curiosity and Polarities

Curiosity keeps the door open to learning no matter what the situation. If we can remain curious, then we maintain presence, awareness no matter what is going on. If we remain curious when our spouse is angry about something we have done, then we don’t fight, we bond and grow together.  Although curiosity may have killed the cat, we believe curiosity is the essential first approach to addressing conflicting issues (polarities).

As we noted in our previous essay (Fish and Bergquist, 2022), polarities are best resolved by remaining engaged with each side of the polarity until we fully appreciate its potential validity and benefit. Only then do we move to the negative side of this polarity. If we move too soon to the negative side and abandon our curiosity regarding each polarity, then we move prematurely to preference for one or the other polarities. In the face of polarity, we begin Either/Or thinking. We choose “to play favorites”, become attached to specific limited outcomes, and take up opposition to one of the sides.