The philosopher Isaiah Berlin structured one of his most famous essays about the literary masterpiece, War and Peace, by Russian author Leo Tolstoy, on a quote from the Greek poet Archilochus (640-685 BCE): “The fox knows many things, but the hedgehog knows one big thing.” Berlin essentially described a dichotomy of thought, practice, and philosophy, contrasting “hedgehogs,” who might view the world through a single unifying idea, and “foxes,” who thrive on adaptability and their breadth of knowledge and experience. 

Berlin argued that Tolstoy, like Shakespeare, Pushkin, and Michel de Montaigne, was a fox who drew on history and experience in formulating his vision of life, but ultimately wished he could be a hedgehog, who, like Plato, Dante, or Dostoyevsky, could view the world through the lens of a single overriding idea. Berlin succeeded in presenting these two very different and opposable approaches to life without favoring one over the other. 

Since its publication in 1951, however, philosophers, psychologists, business professionals, educators, political leaders, and scientists have ferociously debated the metaphor of the hedgehog and the fox. For example, just a few years ago, author David Epstein reflected on differences between hedgehogs and foxes in his best-selling book, Range: why generalists triumph in a specialist’s world, writing that hedgehogs (specialists) “tend to see simple, deterministic rules of cause and effect framed by their area of expertise…whereas “foxes (generalists) understand that most cause-and-effect relationships are probabilistic, not deterministic,” arguing the benefits of breadth and diverse experience in a world that incentivizes hyperspecialization. 

Medical education, and much of medical practice, is at a crossroads regarding the contrast between specialists and generalists. The fox-like health care provider values breadth, adaptability, and creative problem-solving. Applied to medical education, the fox embodies the need for diverse strands of knowledge, interdisciplinary collaboration, systems thinking, synthesis, and integrating humanities training into medical curricula. The hedgehog approach, however, has dominated traditional medical training to cultivate depth of knowledge, expertise, technical skill, and precise systematic thinking within a well-defined framework to understand and competently manage disease processes.

In my opinion, our challenge is to cultivate “hedgehogs who can think like foxes.” Ambiguity and doubt must not be viewed as weaknesses but as manifestations of our humanity. While alternate ways of thinking about pathophysiology, diagnosis, therapeutics, technology, and scientific discovery must always be considered, a firm and concise direction for each must ultimately be chosen, especially in fields where results are quantifiable and judged on evidence-based results.  

Our goal, therefore, is to be deeply grounded in scientific knowledge and understanding as well as to be both rigorous and flexible in thought and medical practice. Knowing the general distinction between hedgehogs and foxes, and recognizing which of these two approaches we align with most naturally during our lifelong journey through a rapidly evolving medical landscape, is an essential step to greater self-awareness.

• Isaiah Berlin. The Hedgehog and the Fox: An essay on Tolstoy’s View of History. OceanofPDF.com., Princeton University Press. First published, 1951.
• David Epstein. Range: Why generalists triumph in a specialized world. Riverhead books. New York, 2019.