EDITORIAL

Prev Next(26) 6 Dec 2019

Are You A Hedgehog Or A Fox?

In 1953, Isaiah Berlin, a 20th century Oxford philosopher, wrote an essay, The Hedgehog and the Fox, which reviewed

the different types of knowledge that were first attributed to the ancient Greek poet, Archilochus.1,2 This apercu of the contrast between the specialist and the generalist was incorporated into Aesop’s Fables in 1484.1 Berlin’s message was that thinkers fall into two categories: hedgehogs, who view the world through a single, central vision and foxes, who chase scattered ideas pursuing many ends. He surmised that hedgehogs were simplifiers and foxes were multipliers. The old proverb, “the fox knows many things; the hedgehog, one big thing” sums up the quiddity of the message.

Although some urologists are a blend of both a hedgehog and a fox, more and more, it seems to me, urologists fall into one camp or the other. The worlds of the specialist and the generalist continue to diverge. The specialist knows more and more about less and less, while the generalist knows less and less about more and more. In urology, this bifurcation of expertise seems to be increasing. It is not uncommon for the prostate cancer specialist to feel uncomfortable managing a patient with renal colic, but many general urologists feel equally uncomfortable counseling a patient on the subtleties of treatment choices for metastatic prostate cancer.

The hedgehogs are more likely the big idea people, more decisive, while the foxes are more open to nuance, more open to using different approaches to different problems.3 Peter B. Nichol is a healthcare business and technology executive who proposed a questionnaire to enable individuals to determine if they are hedgehogs or foxes.2 It appears below:

1. Do you focus on one central theme?

2. Are you fond of best practices?

3. Do you start with a belief and then look for information to support it?

4. Do you apply conventional thinking to modern problems?

5. In the case of evaluating competitors, do you have a formula?

6. Do you evaluate lots of little things when researching a problem?

7. If someone asks you to solve a business problem (you can substitute medical problem), do you ramble a bit and struggle to identify the best single approach?

8. Are you cautious of new or emerging technologies?

9. Does every situation require a new approach?

10. Are you quick to acknowledge your mistakes in business (medicine)?

If your answer is yes to the majority of the first five questions and no to most of the last five questions, you think like a hedgehog. If you answered no to the majority of the first five questions and yes to most of the last five, you think like a fox. One can only speculate whether the future of urologic practice will be marked by a greater division between hedgehogs and foxes.

Kevin R. Loughlin, MD Harvard Medical School Boston, Massachusetts, USA Associate Editor

References

1. A summary and analysis of Aesops ‘The Fox and the Hedgehog’ fable. https://interesting/literature.com/2019/04/17/ a-summary-and- analysis-of-aesops-the-fox-and-the-hedgehog-fable. Accessed July 16, 2019.

2. Nichol PB. Decide if you’re a hedgehog or a fox. https://www.cio.com/article/3151060/decide-if-you’re-a-hedgehog-or-a-fox.html. Accessed June 3, 2019.

3. Schmidt J, Vedantam S, Bogle T. The Fox and the Hedgehog: A story of triumph and tragedy. NPR-The Hidden Brain 7/18/19. Accessed August 1, 2019.

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