Montagues vs Capulets

feud  fjuːd/
noun
  1. a prolonged and bitter quarrel or dispute.
    “his long-standing feud with Universal Pictures

verb

  1. be engaged in a prolonged and bitter quarrel or dispute.
    “Hoover feuded with the CIA for decades”
    synonyms: quarrel, fight, argue, bicker, squabble, dispute, clash, differ, be at odds,be at daggers drawn;

Human psychology can be very strange, to be sure, and sometimes it defies all logic. I’m thinking here of long-running feuds, squabbles, conflicts and wars of attrition that lose sight of the greater good and the common ground by virtue of the driving imperative to win the particular battle. 

Anyone familiar with Romeo and Juliet will know only too well the unseemly and pointless feud between the Montagues and the Capulets, for reasons lost in the mists of time. In everyday behaviours the mutual animosity has been so inbred within each faction that family members are imbued with hatred from birth. It was taken as read that this hatred was all-consuming, so for one member of each to fall for a member of the other was met with disbelieving shock and a tragic conflict resulting in needless death. You wanted to bang their heads together to see sense.

Translated to the streets of NYC in West Side Story, the hostility morphs into one conflict between the Sharks (Puerto Rican) and the Jets (Irish), but it could have been Tutsis v Hutus, Muslim v Hindu, Protestant v Catholic, any two groups since such grudges exist the world over. Many such rivalries are effextively turf wars, battling for supremacy over one domain, physical or virtual, though some exist solely because of which encampment people happen to be in. It’s often said in politics that it’s easier to make friends with people in a rival party than in your own, since they are the ones you are competing against.

To that context I’d like to add one more such bitter rivalry.  In this case it’s a lot more parochial and between colleagues who really ought to know better. However, there is a small problem: for professional reasons I can’t name them. So imagine an Acute Trust in a very lovely part of the UK, comprising two large and busy hospitals in the main population centres, and a number of satellites in smaller towns. The main two hospitals are maybe 8 miles apart, but they might as well have been in different countries.

The two merged into one entity some years back, more than sufficient time for the board to integrate cultures and organisational structures, for processes to be redesigned and differences eradicated. And it’s true – some medical and surgical specialties have buried hatchets and work seamlessly for the good of patients and in the most efficient way possible, regardless of locations. In other cases agendas and antipathies linger, to the extent that those in authority barely dare raise the thorniest issues.

Essentially it’s a battle royale over which hospital should dominate, be the main focal centre for patient services. It means that since few services can be united in one location without causing a political storm, most continue uneasily in both locations. A surgeon from hospital A will never operate at hospital B, even if capacity is available there but not at his “home” hospital. Patients requiring surgery not provided in-house are sent to two separate locations. Patient pathways are often very different, meaning that for the same condition you may have two completely different treatments and very different waiting times, depending on where you are referred, while separate case conference meetings take place on each site. I could go on but you get the picture that the twain barely talk let alone co-operate – though they will refer to one another in coolly professional terms.

Now the clinicians concerned can almost certainly come up with a range of plausible explanations for their choice, as might any protagonists in these situations, but you will always get half a story – never the real hidden agendas. They do meet on occasions but with relations generally being cool progress is often difficult to come by – and they each know the history.   Any unwitting chair choosing to raise these issues will sabotage any goodwill in the process. Bottom line is this: progress on change and improvement is horrendously slow and the needs of the patient seem to come a poor second, despite the persuasive arguments that are quoted in terms of the patient’s interests.

But you want to know the biggest irony? They will actually agree on a fair number of issues – but will never acknowledge this fact!  This is a curious paradox, possibly not unrelated to Catch 22 but has its roots in the psychology that these people are so determined to be enemies that they could not countenance agreement under any circumstances, on principle. The result is stalemate and known inefficiencies that nobody will address for fear of conflagration.

So how do you overcome such entrenched positions? The answer is you don’t unless you have the greater appetite to be the meanest mother in town. Arguably someone at the top should have forced a showdown years ago, and if that meant a few bruised egos chose to tender their resignations, so be it – the principle would have been established and a new team could have been built about the integral Trust strategy.

But that didn’t happen and it won’t – so the Trust has no clinical strategy as such. Waiting for dead men’s shoes may not work either, since the senior men retiring will presumably have indoctrinated the next in line long since, so the dynasties and the wars pass from generation to generation with each amplifying the message in turn. As the saying goes, nothing changes if nothing changes.

What puzzles me is why there is a need for such enmity if the evidence suggests we actually achieve far more through tolerance, understanding, co-operation and constructive empathy. Clearly it touches on a deeper level of the human psyche, such that even apparently trivial matters can become hugely sensitive to the point where the conflict consumes all about it and becomes a raison d’être in its own right.

My approach to life remains one of pragmatism. I may fall out with people occasionally but I don’t bear grudges and aim for compromise on even polar opposite opinions – not that there aren’t principles worth standing up for. Many political and religious principles are not relevant in the modern world, though I acknowledge some believe in them fervently. The answer is that we should all question our beliefs and test them against evidence, then accept when we are wrong and change. Also, we should never lose sight of the bigger picture when reviewing a smaller facet or component held deep in our hearts.

But how many people truly admit they were wrong and say so in the public domain? Not many. For most of us changing our opinions is a long and slow evolutionary process, particularly when there is much peer pressure to stand firm and be resolute. Losing face to strangers is one thing but to reject things you’ve stood up and fought for before your family, friends and colleagues takes rare courage. Don’t follow the crowd is the best advice but in practice being sheep is what we do best. Comparatively few are cut out to be leaders and to buck trends, but we can all contribute towards making things better, if we use that gift wisely.

At any rate, remember this: life’s way to short to engage in feuds, so far better to be positive and fight for what makes the greatest difference to the greatest number. Perhaps Jeremy Bentham had a point with utilitarianism?  Pragmatism – and common sense – should win out. But then how often do people back down when they have their ego and effort invested in one side of an argument?

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