Baa-ram-ewe! Baa-ram-ewe! To your breed, your fleece, your clan be true

Who earns your loyalty and why?

It's a tough question because we rarely think about who or what gains our loyalty. The sheep in Babe give their hierarchy in the title of this post, but for clinicians the distinctions are not always clear.

Is it your practice or department which comes first? Is it your speciality? Is it your health community?

It is too trite to say that you are loyal to your patients, especially since all too often it is they who remain loyal to the practitioner who has failed them in the past.

This loyalty issue has a nasty inverse consequence. I recently met someone who worked for a specialist trust. She described consultants from that speciality who worked in nearby DGHs as having failed to attain the standards required to work in her organisation, and in effect, not fit to treat her dog.

When loyalties are put in conflict, such as organisational mergers we are likely to see reactions which are unpredictable, possibly aligned to loyalties not apparent to those outside the group. These conflicts will be increasingly common as the commissioning agenda develops.

What kind of bike do you ride?

Do you ride a bike? What kind of cyclist are you? If you ride a bike you know what I mean, generally there are two tribes, the roadies and the MTBers. Although the are different demographic features of the two groups, certainly different appearances and features in the various bits of mechanics they employ in their leisure pursuits, I would like to suggest that there is a more fundamental difference in the way you think in the two pursuits. As a Roadie the Tarmac is endless, your body settles in to the rhythm, the pace line, the drafting and, odd pot hole aside, the Zen. The mental quiet, conversation and interaction in the group is the reward and in many cases reason to be a roadie.

MTBers on the other hand are always physically interacting with the bike, the terrain, the changing challenge, conversation is impossible especially on the "gnarly bits". The impact is that MTBers focus on the here and now, no chance to think beyond the next rock, dip or bend.

Neither group is superior to the other, no one is wrong or right. They are just very different in how the same activity is performed and the thought processes which the activity requires and generates in it's performance.

Medicine is like that, we have at the moment two tribes, the generalists and the specialists, each performing and to a certain extent thinking in different ways. 

Neither is "better" than the other and both are required to deliver a functional healthcare system. 

My issue at point is that there are a group of cyclists who are happy to wear Lycra, ride the road, accept the zen of the racing bike on a Sunday morning. Those same cyclists will have been out on the Saturday morning attacking the trails, making the jumps and wearing the baggy shorts of the MTBers. 

Where are those who straddle both primary and secondary care? The GPWSI is one breed, but the Consultant with interest in primary care is not yet on the map.

Should it be? Isn't there a piece missing from the landscape? Perhaps consultants in intermediate care are the closest we have at present but their value needs to be recognised and we all need to recognise the beauty inherent in each others craft.