Expertise

“What would you do if you had this problem?” My patient asked.

This question is problematic for many reasons. Would it surprise you if I recommended something different for my patient and myself? It shouldn’t. The art of medicine often requires applying a treatment to an individual rather than to a disease. The same disease can have different treatments depending on what each individual patient wants or needs. If I am the patient, I may choose to go on a hunch. I may avoid a treatment because the risk is too high for me. I may be a “naturalist” due to my upraising and fundamentally distrust intervention.

You ask me what I would do because you view me as an expert.

Expertise is not a level reached or a degree earned. Expertise is best understood and experienced as a dynamic, rather. It is dynamic not only because information is always being created and disseminated, but because this dynamic body of information has to be interpreted and applied to a unique individual or situation. I, as the physician, may have a good knowledge of the disease, but you, as the patient, have a good knowledge of your own body, your own risk tolerance, and your own expectations. Together — and only together — we are the expert.

Yes, it would be easier for you to hear what I would do and simply rely on that advice. My job is to often avoid what is easiest and try to recommend what is best.

The days of eminence-based medicine have been replaced by evidence-based medicine and will soon be replaced by concurrence-based medicine.

Believe me, I would rather tell you what I would do. It is quicker and easier to be paternalistic than to share in the dynamic of expertise, but by doing you a favor, I am doing you a disfavor.

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