Volume 7 no 2


Johny Van Aerde, MD, PhD

Back to Index

“The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.”

– F. Scott Fitzgerald


Johny Van Aerde, MD, PhD


“And” is a powerful word for leaders in health systems. As the health care industry has evolved at an ever-accelerating pace over the last few decades, health care providers have been faced with treating more patients AND having fewer resources, with using standardized evidence-based practices AND meeting the individual patient’s needs. Physicians are expected to implement new technologies AND maintain the personal touch in patient-centred care, something that has become particularly acute with the accelerated use of virtual care. The tension between all these pairs, between these apparently opposite poles has been amplified by COVID which has also introduced even more dilemmas.



Interdependent pairs of alternative viewpoints are called polarities.1,2 Opposite poles need each other over time to reach outcomes that neither one can reach alone. However, it is foreign to think of opposites as connected and concurrent. Thus, the challenge involves reconciling polarities – two seemingly opposing values that can complement each other when applied in a balanced way.


Polarity thinking is about “both-and,” moving away from a “you are wrong and I am right” view to “we are both right.” This kind of thinking doesn’t replace problem solving; it supplements, and should supersede, our traditional either-or thinking and acting.


Polarity thinking helps us balance the tension between two competing values, rather than favouring one over the other. Often, there is emotion and bias between the poles, which makes us fall into the trap of choosing. Consequently, we become engaged in a battle between values, rather than leveraging the two poles and fighting for both in balance. The result is that nobody wins.


When an issue arises, step back and ask, “Is this a problem or a polarity?” For example, during this pandemic crisis, the problem to be solved is not just the population’s health or the economy; there is a need to balance both health AND economy. Another polarity is the acute stress on our health care system caused by COVID-related disease AND the need to maintain access to regular health care services for non-COVID illnesses. The COVID pandemic also has us struggling with the old but very powerful polarity, individual freedom AND the common good; the controversy over mask-wearing falls under that category. This is not new, as societies throughout history have had to find ways to provide for the collective (liberal values) while also meeting the needs of individuals (conservative values). In short, polarities are unavoidable and are present in every individual, team, organization, and nation.


One of the major differences between problem solving and polarity thinking is the demand for continuous vigilance to leverage the polarity. Leveraging a polarity is not easy, particularly when you have held a strong preference or bias for one pole over the other. It requires you to do the hard work of committing to real actions that effectively reap the benefits of both poles.


Canadians have approached the COVID crisis as a problem rather than a polarity. Such an approach might be acceptable for a very short period during the initial chaotic phase of a crisis, but once the situation has entered a more chronic phase, polarity thinking is crucial to minimize the losses for all. No matter which pole we favour, the losses will affect everyone. For example, if we overfocus on controlling the virus without paying attention to the economy, the latter will collapse, creating a different variety of health issues for Canadians. As a result, both health and the economy will be affected negatively. On the other hand, if we overemphasize the economy with insufficient attention to the health aspects of the virus, the virus will cause so much havoc that neither the health system nor the economic system will have enough healthy people to sustain it.


Unfortunately, our society seems to have difficulty managing polarities. The word “and” is absent from the vocabulary of many politicians and those who elected them, leaving little room for collaboration against a common enemy. As physicians, we were trained to solve either-or problems. As physician leaders, it behooves us to be aware of polarities and our own biases favouring one or another pole. To balance the many polarities the current crisis has accentuated, we have to use the word “and” much more frequently. If we don’t, everyone will ultimately lose.



1.Johnson B. And: making a difference by leveraging polarity, paradox or dilemma. Amherst, Mass.: HRD Press; 2020.

2.Wesorick B. Polarity thinking in healthcare: the missing logic to achieve transformation. Amherst, Mass.: HRD Press; 2016.



Johny Van Aerde, MD, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.


Correspondence to: