4 Essentials For Expertise
I saw a video that I thought was fascinating and thought about how it applies to expertise in botanical medicine.
Veritasium on youtube: What makes an expert.
10,000 hrs is not enough
The video concluded that there were 4 aspects required to make a true expert rather than someone who has simply spent time in a given field. I started to reflect on the following with regard to medicine.
Repeated attempts
Stable environment
Timely feedback
Deliberate practice and discomfort
Repeated attempts
Education and experience are important, however, it is the quality of this experience which differentiates experts from people who have simply solidified their mediocrity. With the right kind of repeated exposure you can begin to see meaningful patterns and chunk information into groups to make it easier to navigate. Expert chess player can glance at a board and later replicate every piece on it. Expert martial artists can see a fight happen in a flurry of hits and describe each one from the perspective of both opponents. When repeated attempts are placed within the context of all four factors, the ability to predict and provide prognosis becomes increasingly accurate. It is the ability to anticipate and predict future events which makes expertise so valuable.
2. Stable environment. The greater the variety of diseases you treat, the less skilled you will become at any one of them. It is also important to make sure that our patients are stable enough to provide accurate intel for our growing practice. If they are not compliant then the experiment is compromised and the information you get back is not accurate. Most of our early experience comes from student clinics and internships. Student clinic is a double edged sword because people who aren’t that serious about their health or want attention tend to come. They aren’t very compliant and don’t tend to take the student advice very seriously. So there are repeated attempts, but the environment is not stable. It is more chaotic than a well referred patient who is there to take their health seriously and will be coming for the duration of the treatment cycle.
3. Timely feedback. I shadowed many doctors in China during my first visit, but we saw so many teachers that I never got to see the same patients repeatedly. I had no idea whether the prescriptions were effective or not. While I had tremendous exposure, the quality of it was insufficient to provide me with any background for expertise. It was only after staying in China for years that I could see the long term effects on patients. The most valuable lessons I had were in seeing doctors make mistakes and how they corrected them.
4. Deliberate discomfort and failure.
The last area is a balancing act. On one hand if you aren’t failing, you aren’t growing. on the other, if you are failing too much you will get demoralized and lose confidence and report with patients.
Based on research on the dopamine system it’s a good idea to do the same thing the majority of the time so you are in the habit of winning, but keep a handful of cases that are really difficult to keep you interested.
In my experience if you aim for stability and attempt treat the same kinds of cases in order to achieve repeated attempts in a stable environment there will still be those which are unexpectedly fascinating. Someone may come in for chronic fatigue and mention at the last second as they walk out the door that it may be due to their bone cancer or HIV. “WTF??? you think, Why didn’t you mention this before?” This way you get the mental stimulation and risk of failure while also maintaining a high success rate.
Constantly taking new challenges takes you out of the stable environment making it impossible to see enough of the same thing to begin chunking information. Still it is those challenging cases which keep you up at night and bring your thoughts to the patients treatment strategy at all hours of the day and drives you to dive deeper into the books and seek out mentorship with experts in the field required to help the patient.
Xun Zi, a Chinese philosopher said that a nation is best run when government officials are bored. If they are elevated too quickly they will be promoted to a place of incompetence. Eventually the entire government will be operating at 20% capacity instead of 100%. We need to grow and take on new challenges, but must balance this with sticking to what we are already competent in the majority of the time in order to refine our craft and develop true expertise.
10,000 hours will pass regardless of what you do. Whether you take a hard road or an easy road largely determines whether you develop expertise with prognosis skills or simply rest on the trembling legs of habitual mediocrity.
Consider designing your life and your clinical practice with these four factors in mind so you can become a category expert in a shorter period of time.
When we look at this list honestly we have to come to terms that we won’t be experts in every specialization. We will truly need to trust and depend upon our colleagues to do their best on their journey. The more they flourish, the more we all flourish as a profession.
Please share this with a colleague and ask each other how you can support each other on the road to increasing your expertise in your chosen field.
For me, it’s dampness. Is that everything in Chinese medicine? No. But it’s where I focus, where my best work is , where I find challenge. It is where, on occasion, I can be helpful to colleagues as well to help remove some of the diagnostic noise that damp and phlegm bring. Am I am expert on Chinese medicine based on this definition? No, I I don’t think so. I have a very narrow area I have studied and practiced around deeply and outside of that I need to crack open a book or ask a colleague.
References I shamelessly stole from the Video:
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