‘Divided we fail’: understanding inter-relations and the role of the generalist

Abstract

The Harveian Oration, an annual event at the Royal College of Physicians (RCP), was established by William Harvey in 1656. In October 2011, Iona Heath, President of the Royal College of General Practitioners, was invited to speak — the second GP ever to do so in over 350 years. We reflect here upon some of the important issues discussed within this oration, but also urge the reader to seek out and enjoy the original and inspiring text. At its centre is her invitation to expand our repertoire of care and kindness towards patients. Harvey determined the oration should be delivered on the Feast Day of St Luke’s (patron saint of the physician). Iona pays tribute to the relevance of St Luke’s gospel as a source of miracles and parables concerning healing, kindness, and concern for the poor: an approach this piece itself replicates. In her Oration ‘ Divided we fail ’ Iona draws upon experience, literature, and research, including her 35 years of clinical practice.1 She uses a multifaceted lens to examine the professional work of doctors through a series of dyads. These include the central dyad of medical practice: doctor–patient; the key dyad of the NHS: generalist–specialist; and the Cartesian split of mind–body. These dyads also extend within her text to illness–disease; subject–object; life–death; technis–praxis; and collaboration–competition. Why dyads? Viewing the world as ‘divided’ facilitates our understanding of relationships. This may invoke ideas of synergy, balance or harmony between component parts: ‘But let there be spaces in your togetherness, And let the winds of the heavens dance between you. … And stand together yet not too near together: For the pillars of the temple stand apart, And the oak tree and the cypress grow not in each other’s shadow.’ Kahil Gibran On Marriage (1923). However, Iona also uses …