As I mentioned a couple of weeks ago in my post, "The 80 hour work week", I recently attended the 12th Annual Congress of the World Federation of Pediatric Intensive & Critical Care Societies. It was a great meeting, and I really enjoyed seeing a lot of colleagues from around the world who I've not seen since prior to the COVID-19 pandemic. I really enjoyed a session by Dr. Neil Spenceley, a pediatric critical care physician in Glasgow, Scotland. His talk was entitled, "Do we need competent staff or experts in the PICU?" During the talk, Dr. Spenceley came up with what I thought is one of the best definitions of "expertise" that I've ever heard (and of course I told him so!). To his credit, he told me that several colleagues (Spenceley, Matt Scanlon, Keith Catchpole, and Carl Horsley) came up with the definition in a conversation over e-mail. They defined expertise as the ability to adapt to the unique and tolerate uncertainty in a particular field.
Their definition of expertise is simple, yet elegant and generalizable to any field or discipline. First, if you are able to adapt to a unique situation (in your chosen field - that's important) that you've never encountered previously, then you are an expert. Second, if you are able to tolerate uncertainty (remember our VUCAT world) without stressing out, then you are an expert. I am reminded of Rudyard Kipling's famous poem "If", in which he says, "If you can keep your head when all about you are losing theirs and blaming it on you," then you are an expert (I'm paraphrasing this last part)!
The English poet (and physician) John Keats labeled this ability to tolerate uncertainty "Negative Capability" in a letter to his brothers dated December 21, 1817 about an ongoing disagreement he had with another poet, Samuel Taylor Coleridge:
...at once it struck me what quality went to form a Man of Achievement...I mean Negative Capability, that is, when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason.
Of interest, Keats only used the term once in all of his writings, though as a physician he would certainly appreciate our fear as humans of the unknown. Arabella Simpkin and Richard Schwartzstein wrote a wonderful editorial in the New England Journal of Medicine called "Tolerating Uncertainty - The Next Medical Revolution?" (which begins with Keats' quote above). They wrote that "our quest for certainty is central to human psychology...being uncertain instills a sense of vulnerability in us - a sense of fear about what lies ahead. It is unsettling and makes us crave black-and-white zones, to escape this gray-scale space." Drs. Simpkin and Schwartzstein further suggest that our inability - in this case referring specifically to physicians but I do think this applies more generally to all professions - to tolerate uncertainty may actually be partially responsible for the increase in burn-out today. Lastly, and perhaps most importantly, they suggest that clinical algorithms and protocols (which may in the very near future be based upon artificial intelligence) will be used to perform the routine diagnostic and treatment tasks in medicine, saving the world of the unique and uncertain for the clinical experts.
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