Thursday, 28 August 2008



It is often forgotten that the greatest achievements of humanity were attained by men who preferred solitude to socialization. Almost all the great prophets discovered God by means of solitude, by escaping society and social norms, and immersing themselves in deep thought. Didn’t the Prophet Muhammad (PBUH) try “to uncover the mysteries of creation, of life and death, of good and evil, and to find order out of chaos (by solitude)…. Solitude became a passion for him, and every year he would retire to the cave for the whole month of Ramadan to meditate?”, and wasn’t it when he was “on one of these occasions, when he was 40 years of age, when Muhammad received the call. One night, while lying absorbed in his thoughts in the solitude of the cave, Muhammad was commanded by a mighty voice to go forth and preach”? Islam is a product of God’s grace and the Prophet’s solitude.

Was it not in the solitude of night that the Prophet Abraham (PBUH) discovered God, as outlined in the Quran, “Thus did We show Abraham the kingdom of the heavens and the earth that he might be of those possessing certainty. When the night grew dark upon him he beheld a star. He said: This is my Lord. But when it set, he said: I love not things that set. And when he saw the moon uprising, he exclaimed: This is my Lord. But when it set, he said: Unless my Lord guide me, I surely shall become one of the folk who are astray. And when he saw the sun uprising, he cried: This is my Lord! This is greater! And when it set he exclaimed: O my people! Lo! I am free from all that ye associate (with Him). Lo! I have turned my face toward Him Who created the heavens and the earth, as one by nature upright, and I am not of the idolaters” (6:75-79).

Indeed, it is partly this depiction of solitude as an abnormal attitude by the majority of Western society that has led to a decline in creativity and the products of solitary genius, in virtually everything in life. Group activities, and being a team player, are the most important things in modern society. Individual genius is most often disregarded unless it is rebuilt, remoulded and then incorporated in and utilized by a team.

This is why a player like David Ginola, one of the most magnificent footballers I have ever seen, “considered by many in English Football as one of the best wingers of all time due to his "magical" touch on the ball and his ability to get past players from any type of position and then manage to score a goal”, played just 17 times for France. It is because of a team mistake in a World Cup qualifier with Bulgaria in 1994, when with the match poised at 1-1, “Ginola lost possession instead of holding onto the ball and the move resulted in Emil Kostadinov scoring a surprise winner to knock France out. The French manager Gerard Houllier blamed Ginola for the defeat. Aimé Jacquet (France’s subsequent manager) did not select Ginola for any major tournaments. Ginola played his last match for the national team in 1995.” It is partly this disdain for individual genius and its oppression by team work, the desire for managers to have players with physical prowess and team work capabilities rather than creative flair and individuality that has ruined football for many of us. That is why teams like Italy and Greece, two teams that completely lack individual genius (or suppress it so well – no one can deny that Francesco Totti and Alessandro Del Piero are blessed with great football brains) won the last World Cup and European Championship respectively, and why a team like Argentina, which is blessed with flair and individual genius in nearly every single department, has not won anything since 1993.

That is also why nearly all Nobel Prizes for physics, the mother of all sciences, since 1970, have been awarded to two or more people, who often collaborated to reach a conclusion. It is only in 1971, 1982, 1985 and 1992 that the prize was awarded to one person.

This emphasis on team work is seen everywhere. A 2003 American national representative survey, “revealed that Americans think that 'being a team player' was the most important factor in getting ahead in the workplace. This was ranked higher than several factors, including 'merit and performance', 'leadership skills', 'intelligence', 'making money for the organization' and 'long hours'.” The famous ‘Bristol Inquiry’, concluded with a section entitled, ‘A culture of teamwork’, saying, “Teamwork is of crucial importance in its own right; its continued development will serve to break down the tribal barriers referred to earlier. Collaboration between professionals is the core of what we mean by teamwork. Many healthcare professionals will believe that they have always worked in teams, such that there is nothing new here. In the past, the `team', more often than not, consisted of individuals from only one group of professionals, with the most senior person being in charge and the rest following, like it or not. Such historical arrangements may have suited administrative convenience or the niceties of professional etiquette but they did not necessarily suit the patient. Teamwork as a means of serving the patients implies a multi-professional team and a sharing of responsibility. The team leader may not necessarily be the most senior member of the group and, crucially, may not be a clinician, if the circumstances are such that some other professional should take the lead. Leadership is based on ability and function in the context, rather than some title or professional qualification. Moreover, teams must cross the boundaries of profession and discipline. We note the efforts on the part of professional bodies to promote multi-professional teamwork. The GMC, for example, in January 2000 issued guidance on teamwork in medicine. It is, however, a sign of how much things need to change, and singularly ironic, that such advice about professions working together is issued by a single professional group. Multi-professional teamwork needs multi-professional guidance and multi-professional leadership. Teamwork is the collective collaborative effort of all those concerned with the care of the patient. Patients do not belong to any one professional; they are the responsibility of all who take care of them. We conclude as we began. The culture of healthcare, which so critically affects all other aspects of the service which patients receive, must develop and change. Fundamentally, this will be achieved through education, through learning new ways to work and through forging new links within and between professional groups. It is instructive to recall the words of Professor Lucian Leape during one of our seminars: `Culture is not amorphous, nor immutable; we are not powerless to change it. It is in some respects no more than the sum of the actions and attitudes of many individuals. Thus, if in some crucial areas of practice we can change the rules, the regulations and incentives, behaviour and, ultimately, attitudes will follow.' We agree. We now turn to a consideration of what the patient is entitled to expect from a changed NHS. We begin with respect and honesty”.

Indeed, it is partly for this reason, the lack of individual genius and flair, that medicine has lost much of its vigor and attraction. Humans are attracted by flashes of individual genius and flair, and I have seen very little of this in hospital medicine. I have seen a few doctors and surgeons who have amazed me with their knowledge, and the way it is suddenly recalled, almost on demand, and with effortless ease, and made me think, ‘Wow!’ But that is very rare. It is often their personalities and individual charisma that we, and their patients, find most attractive and fall prey to.

Western society (which of course extends into most of the rest of the world today) has killed ‘the Genius’. Its very flourishment and abundance of comforts and leisure is the reason for life within it becoming so boring, tedious and dull. I remember coming across an article that tried to explain the football genius of Diego Maradona, saying, “With no money for food, accommodation or travel, they would have to rely on their football skills and street smarts to hustle their way across the world”. It is only struggle, pain, and deprivation that brings out the best in mankind.

It seems some degree of suffering is essential for all sorts of human progress. It seems that the world’s very imperfections are the reason for the very progress in most fields of human endeavor. I remember writing an essay a few years ago on the history of vascular surgery, where I highlighted that, “Analysts of the human adventure have long regarded pain and death as among the most powerful stimuli to scientific and medical creativity. In ‘The World As I See It’, the great Albert Einstein stated his belief that, “Everything that the human race has done and thought is concerned with the deeply felt needs and the assuagement of pain”. The late Elisabeth Kubler-Ross, famed for her work on the stages of death, once stated that, “For those who seek to understand it, death is a highly creative force. The highest spiritual values of life can originate from the thought and study of death”. The inevitability of death brings out all that is best out of the potentially creative minds that contemplate it – for it drives them to accomplish tasks that outlast their lives, in an attempt to defy mortality. Death is especially significant as a creative force in medicine and surgery, partly because it is a central issue in both, and that reduction in mortality is one of their fundamental tasks. War acts as a creative force for medicine and surgery because of its large-foci of mortality, and during its many moments of desperation, it provides ample opportunity for experimentation.”

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