Tribalism in Medicine: Lessons From the Celtic-Rangers Soccer Rivalry

This Ignite! talk explores how Franklin Foer’s How Soccer Explains the World—particularly his analysis of the “Old Firm” Celtic–Rangers rivalry—offers a powerful lens for understanding tribalism in medicine. Two emergency physicians (one a Chelsea fan, the other an Arsenal supporter) will use their own playful rivalry to show how identity can divide or unite teams—and why the stakes in the ED make this more than a game. For those unfamiliar, the “Old Firm” is Glasgow’s centuries-old rivalry between Celtic (Catholic-aligned) and Rangers (Protestant-aligned), rooted in sectarian divisions that make matches fiercely passionate and sometimes violent. Foer argues these loyalties endure because they provide belonging in an increasingly fluid world. That insight resonates in healthcare: under stress, clinicians retreat to familiar identities—“my specialty,” “my shift,” “my team.” Tribalism reflects strong identities that separate groups, fostering loyalty to “us” and suspicion of “them.” In hospitals, tribes form around specialties: emergency physicians, hospitalists, consultants—not to mention the dreaded “outside hospital.” These identities can boost pride and performance—like an EM physician’s calm under pressure or a hospitalist’s thoroughness. But they also create blind spots. When we elevate our own tribe, we risk disparaging others, often unintentionally. Consider this scenario: a surgeon hasn’t evaluated a patient because they’re tied up in the OR. Meanwhile, the ED physician, juggling multiple critical patients, interprets the delay as disrespect rather than competing priorities. This represents a classic attribution error—blaming character instead of context. Over time, these assumptions harden into stereotypes: - “They’re slow,” “They’re impatient,” “They’re just dumping this patient.” Foer’s insight into soccer tribalism explains why: under stress, humans retreat to familiar identities. In medicine, that instinct can fracture communication, fuel conflict, and harm patients. In soccer, this has even become litigious, with a judge in England ruling that employers are entitled to base recruitment decisions on whether a prospective colleague might “damage office harmony” by not supporting the same sports team as existing staff. Foer argues the antidote isn’t pretending differences don’t exist, but rather, it’s creating a larger, shared identity that supersedes them—what he calls “old-fashioned nationalism.” In the “Old Firm”, fans who normally loathe each other unite behind the Scottish national team. When Scott McTominay scored a career-defining bicycle kick against Denmark last November, sending Scotland to its first World Cup since 1998, those divisions vanished in a surge of collective pride. In the ED, our equivalent is rallying around patient care—our “national cause.” When the mission is clear—stabilize the crashing patient, manage the mass casualty—professional rivalries dissolve, and collaboration becomes instinctive. Attendees of this Ignite! talk will leave with insights into how tribalism—like the "Old Firm” rivalry—shapes team dynamics in medicine. They’ll learn why stress amplifies identity-driven conflict, how attribution errors fuel stereotypes, and how the solution is to rally around a shared mission: patient care.