General practice needs more hedgehogs

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The Greek poet Archilochus observed: ‘a fox knows many things, but a hedgehog one important thing’. Two and a half thousand years later this remains true, including for healthcare.

The fox or hedgehog classification is a popular way to divide writers and thinkers. Notable hedgehogs include Plato, Nietzsche and Proust, while Herodotus, Goethe and Shakespeare are dyed-in-the-wool foxes.

Hedgehogs have a singular view of the world that shapes their motives and defines their behaviour. Foxes on the other hand, have many ideas, some of which may even seem contradictory. When hedgehogs feel threatened by anything, they curl into a spiky ball of deviance. When foxes are threated, they may choose to launch a counterattack, flee or cunningly hide.

In the world of business, hedgehog entrepreneurs use specialist strategies. They focus their efforts and resources on achieving a specific aim.

Foxes are generalists and adapt their strategies and resource allocation according to the problems at hand. They usually pursue several objectives simultaneously. While this approach helps to reduce risk, it may also leave them stretched too thin.

Given that foxes and hedgehogs are polar opposites, the debate about who is better is difficult to settle. Our intuitive answer likely reflects our personality and professional preference more than the truth.

My personal feeling is that most general practitioners are foxes by nature. The positive attributes of the fox nature help us to excel in caring for complex and undifferentiated patients from cradle to grave.

On the flip side, the fox nature means GPs seldom agree what our main priorities are as a collective, nor do we steadfastly advocate for a shared vision of general practice. Unsurprisingly, policy hedgehogs easily rebuff our disjointed efforts, leaving our specialty undervalued and under-resourced.

The truth is that we need both foxes and hedgehogs to retain the essential balance in nature. We urgently need to re-balance healthcare from the dominance of secondary care and the proliferation of increasingly specialist services by prioritizing, investing in and building a strong and capable primary care work force.

The only realistic way this will happen is if primary care foxes become a little more like hedgehogs. Foxes are quintessentially adaptable and should therefore be up to the challenge. Just so long as we are not distracted. Oh wait…

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