In this brief narrative we find not only the value of understanding and appreciating a specific polarity but also the struggle that inevitably occurs when abandoning for a moment one’s own firmly held beliefs and preferences. Polarity management is not for the faint-of-heart!

The Drama of Health Care Polarities

We suggest it is not just curiosity that is required to manage the many polarities arising in contemporary health care systems. Courage is also required to deal with the push toward premature resolution of a health care related polarity—courage that is not found among the faint-of-heart. Courage is required not only because of the requisite setting aside of one’s own biases but also because of the powerful forces that arise when confronting the major “life-and-death” polarities that are often found in a health care system.

These forces often take on mythic properties, such as conveyed in movies (such as Alexander Nevsky) directed by Sergei Eisenstein, the noted Russian film maker. He first portrays an empty battlefield—often a large flat plain (with nearby hills) or even a frozen lake.  Eisenstein then offers a series of brief visual images portraying competing armies on this battlefield. He first provides broad screenshots of both assembled armies. He moves back and forth between images of the whole army attacking from the left and images of the other army attacking from the right. Banners and flags representing the values and vision of each army are sequentially portrayed.  The scene then moves to a close-up shot of specific protagonists representing each army. The scene moves from an image of the individual leader or warrior attacking from the left to an image of an opposing leader or warrior attacking from the right side. Then back to the broad screenshots of the two armies racing forward toward one another.

The images shift at an accelerating pace—accompanied by Sergei Prokofiev’s pulsating music. Finally, the battle is engaged, with multiple scenes of individual warriors battling one another—and often wounding and killing one another. The music becomes cacophonous. Everything is swirling about. There is confusion and chaos. Finally, there is calm. The battle is over. Dead warriors are portrayed strewn out over the ground in large numbers. Generals are seen wandering through the body-litter battlefield in great despair. Women are often portrayed searching for their dead loved ones. The music conveys solemnity and grief. There is a crescendo and thundering musical conclusion to this enactment of war.

Each side has its own reason for engaging in warfare (protect the “father land”, revenge the travesty, reclaim long-lost land, etc.) As viewers of an Eisenstein movie, we are enthralled by the dynamic polarizing action. Using Eisenstein’s basic model, we see comparable portrayals of armies in conflict in American and European movies. There are competing leaders, competing images of the “good” and “bad” in all of these movies. Compelling cinematic portraits of conflicts are conveyed that determine the destiny of tribes, communities, nations—even humankind. These dynamic images of polarized forces take on mythic character.

In real life, we find parallel conflicts among competing “armies” of thought, priorities and conviction in the world of health care. Entire systems are at “war” with one another. There are individual leaders, heroes and warriors. There are mounting casualties, and the inevitable grieving of lost opportunities, lost careers and lost sense of purpose and meaning. Silos are competing against silos again and again. Ultimately, no one side ever really “wins” the war. There rarely is real change. Big, frenzied change is enacted on the “battlefield.” These are changes that makes no difference ultimately in the distribution of power in the world of health care.