But ‘Either/Or’ thinking isn’t effective for us in leveraging patient safety AND staff satisfaction or combining technological advancement without losing humanistic medical care.

Consider what ‘Either/Or’ thinking means for Jim (not his real name), a patient Dr. Danielle Ofri described to me (Margaret) during our interview for my new book, The Anatomy of a Good Doctor. Jim needed diuretics and, as a New Yorker, spent his days outside his home, running errands. Imagine you’re in a New York subway stairwell. Close your eyes for a minute and inhale deeply…no bathrooms. Jim’s biggest worry was not taking the medicine at the prescribed times, but the thought that he’d have nowhere to pee.

We need ‘Either/Or’ AND ‘Both/And’ thinking in medicine. We take comfort with ‘Either/Or’, our primary method for making decisions and creating differential diagnoses. It’s useful for solving problems—easy problems. For wicked problems, Barry Johnson and his colleagues at Polarity Partnerships have developed Polarity Thinking to leverage ‘Both/And’ tensions. Bonnie Wesorick pioneered Polarity Thinking in healthcare.


Polarity thinking

Polarities are interdependent values that leaders and organizations must balance to catalyze progress, facilitate positive patient outcomes, and avoid an endless cycle of too much of this, then too much of that, then too much of this: Think Goldilocks and the Three Bears, never getting it “just right.”

Imagine a generation of physicians like Danielle Ofri, who worked with Jim on finding a convenient time for him to take his diuretic so he wouldn’t be caught with a full bladder and nowhere to go. They could use their knowledge of Polarities to understand the complexities of healthcare.

The growth of these physicians begins in medical education. Integrating Polarity Thinking into medical school curricula will help them recognize complex dilemmas and maximize their educational experience.

As I (Jack) prepare to enter my third-year clinical rotations, I ask,

How do we students address the tension between excelling under the standards of traditional medical education while also assimilating the transformative lessons in providing engaged, compassionate care to our patients?

Brilliance lies just beyond this question, in seeing traditional medical education and compassionate patient care as Polarities to leverage.


We need both traditional and transformative medical education

Without traditional medical education, students fail to learn the science behind diagnosis and treatment. Without transformative medical education, students fail to develop the skills to create enriching, empathic patient relationships.

The Polarity Map® is depicted in this model:

MedEd Polarity Map Screen Shot from Cary post (600 x 425)
Screenshot from http://www.gold-foundation.org/wp-content/uploads/2016/07/MedEdPolarityMap_Complete2.pdf

When we leverage the upside benefits of the two poles, we create a virtuous cycle, bringing each of us closer to the greater purpose of becoming a competent, compassionate physician. Likewise, when we let one pole dominate at the expense of the other, we create a vicious cycle, depriving our patients of the care they deserve and ourselves of the engaged environment that optimizes our education.


Leveraging the tension

What can we do to leverage the tension and move towards the greater purpose? One idea is to create a Polarity Map® and Five-Step S.M.A.L.L. process:

  1. Seeing: what are the two interdependent poles we must leverage?
  2. Mapping: What are the upsides and downsides each pole provides?
    • What is the greater purpose we move toward when we balance these poles?
    • What is the fear of what will happen if we have if we fail to attain leverage?Assessing:
  3. How well or how poorly are we leveraging this Polarity?
  4. Learning: What have we learned from this assessment?
  5. Leveraging: What are the Action Steps we can take to reap the benefits of each pole? What are the Warning Signs that indicate one pole is dominating over the other?

This map shows each pole’s utility and the action steps conducive to success. We walk away with a path to navigate the poles over time.

Medical school is a steep hill to climb. Poorly leveraging Polarities can send us down a slippery slope into burnout, disengagement, and frustration. By recognizing the warning signs of too much focus on one pole, we can adjust our behavior to move into the upside of the other pole.

As with learning to drive a car, our focus here is on course correction.

In our work, Jack as a medical student and Margaret as a leadership coach for physicians, the most valuable part of Polarity mapping is learning to accept the absence of a “check-the-box” solution. We, medical students and physicians, love checking items off lists, knowing we found the correct answer, the solution to a problem. We cannot “check off” ongoing and unsolvable Polarities. We can leverage them to create virtuous cycles of movement from one pole to the other, striving to stay in the upside of both, and minimizing our time in each’s downside.

Once we learn Polarity Thinking, we see Polarities everywhere. Sometimes in our enthusiasm, we may forget the importance of ‘Either/Or’ thinking in healthcare—’Either/Or’ AND ‘Both/And’ are two poles to leverage. Having the tools to see the world through a Polarity Thinking lens adds the capability to leverage complex, permanent dilemmas to our ability to diagnose and treat. Sustainable, continuous progress is no longer a pipe dream. It’s a reality.

Jack said,

“As I walked through this with my study partner, I felt a huge relief wash over me. I realized it’s possible to leverage the two poles (traditional AND transformative education) to attain maximum benefit from both, and to reduce the chances of being pulled toward a one-pole ‘solution’—a ‘fix’ that fails.”

As we think about this, we have reframed our definition of success. Success is no longer about fixing everything, about one right outcome. In Polarity Thinking, success comes from doing, reflecting. and course correcting. The stress from looking for the sole solution we will never find vanishes. More adaptable, progressive, compassionate physicians and leaders emerge, working with our patients to honor their concerns, finding ways to get their care “just right.”

A special thank you to Cliff Kayser and Barry Johnson of Polarity Partnerships for their clarifying edits.

This was first published on The Arnold P. Gold Foundation on July 21, 2016. The article was republished with the author’s permission.

Margaret Cary, MD, MBA, MPH and Jack Penner
Maggi Cary (L) is a family doctor and leadership coach who engages her audiences in highly interactive presentations. Maggi is a doctor’s doctor with a physician’s mind and a friend’s heart. As an executive coach, she blends a scientist’s thinking with empathy. She translates the latest research in leadership development into her coaching process and into entertaining and highly interactive presentations. She is an author, trainer, facilitator, and teacher (Georgetown University School of Medicine). Her authenticity and ability to communicate and connect emotionally with her audience through storytelling—combined with just enough humor—result in rave reviews and standing ovations. She embodies a warm, sincere approach in sharing lessons learned as she guides you in creating your own Leadership Expedition. Jack Penner (R) is a medical student at Georgetown University with an interest in primary care, healthcare leadership, and medical education. He served as a coordinator of Georgetown’s Student-run Free Clinic at the DC General Homeless Shelter, where he created programs in youth mentorship and maternal health. His writing focuses on the medical student experience and helping fellow students develop into engaged, compassionate physicians.


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