Contributor: Robert J. Laskowski, BA'74, MD'78, WG'83
To learn more about Bob, click here.
I am not an expert. And, I am happy about it. I have been a CEO, one with objective success when viewed with the conventional metrics of quality and financial performance, customer satisfaction, employee satisfaction, and longevity in the job. I practiced actively for 20+ years as a physician. In addition, I have been a physician executive for over 30 years. And, in my retirement, I am a busy consultant, both paid and mostly unpaid. Over my long career as a trained professional I have been asked for my advice based on my “expertise” innumerable times. People continue to seek my advice. That is one of the main reasons that “not being an expert” is so important.
Over the years, I have accumulated a large amount of experience in a varied career. These experiences have provided me with diverse perspectives. I have had the privilege of seeing healthcare from many vantage points — as a clinician practicing internal medicine and geriatrics, as the elected leader of a multispecialty group in a group model HMO, as a health insurance executive, as a chief medical officer of an large, open staff voluntary hospital, as a CEO of a large health system, as an academician, and as a consultant on healthcare program development, healthcare management, and public policy. My experiences have taught me much. These experiences form the context of the advice I am asked to give. They frame the metaphors I use and populate the examples I share. However, my “experiences” are not “expertise.” And, my experiences have taught me that I am no expert — at least in the conventional sense.
I value expertise and have often marveled at the experts I have seen in action. To see an expert physician make a difficult diagnosis rapidly with seeming ease and confidence is a wonder. To watch an expert surgeon operate is akin to experiencing a dancer express the nuances of life in a ballet or a soprano summon the most complex emotions with her song. I have been in the audience when an expert speaker electrifies the room with his oratory. I have seen expert leaders deftly engage and energize an entire organization. I have seen expert consultants reveal organizational truths unapparent until the expert’s questions and shared knowledge makes the truths obvious.
My experiences are common ones. We have all experienced expertise and its benefits. Seeing an expert in action is a wondrous thing. Experts do much more than enlighten us. Experts can make us feel reassured and confident. They can engage our energy and inspire us to action. Their words, their recommendations, and their actions can change our lives. They can also lead us to disaster.
Over the past 20 years, there has been considerable research into the field of expertise. This research has been distilled into popular books. The Nobel Prize winner Daniel Kahneman’s Thinking Fast, Thinking Slow1 recounts decades of research comparing the psychological phenomena of fast “intuitive” judgments with slower “thoughtful” decision-making. Malcolm Gladwell’s Outliers2 explores the social conditions and personal temperaments required for the development of expert abilities. Michael Shermer in his Believing Brain3 points out the foibles of human intuition on determining causality. And, from the idiosyncratic viewpoint of an options trader grounded in probability science, Nassim Taleb in Fooled by Randomness4 describes the mistakes human beings make when facing uncertainty. All of these books resonate with a single theme that is echoed in the title of David McRaney’s humorous examples of human limitations, You Are Not So Smart.5 It is humbling, useful, and vitally important to realize that “you are not that smart,” especially if you are a person whose advice is often sought.
Experts are built by innate talent honed by years of relevant experience often guided by excellent mentors. Not everyone can be an expert. Aptitude is required, not just interest or experience. I have played the piano for 60 years, but stand far from the land of experts in musical performance despite my interest. And certainly, even admitting the great range of skills and talent of rare polymaths, no one can be an expert in all things. All these observations would seem reasonably obvious. Less obvious, though, is the narrowness in which most “expertise” functions. Most experts are experts in a narrow zone of experience, and they are grounded in experiences which are, by definition, part of the past. This should make the work of all “experts,” as helpful and reassuring as they often are, open to question.
Some humbling examples from my own experience may resonate with your own. I am certified by a national physician accrediting board as a specialist in internal medicine with special qualifications in geriatrics. By the community at large I would be considered as an “expert” in these areas. And in truth, I do know a lot of medicine. However, life and medicine are not static. They change — continually. Some years ago, as part of my recertification as a geriatrician I was required to complete a number of open book examinations. The questions were clinical scenarios, often of some complexity. I devised what I thought to be a very rational approach to the exams. I would quickly answer the questions that I “knew” and research the ones in which I had a doubt. After I received the results of the first examination, I was surprised to see that my “passing” score was not only not perfect, but was perilously close to the cutoff for “pass” – disturbingly so for my “expert” ego. An analysis of the answers to the questions revealed that my mediocre performance was not due to the questions that I did not know. Those questions I had largely gotten correct despite their difficulty. My shortcoming lay in the areas that I “knew” and had not taken the time to verify. What I “knew” was simply wrong. To test my hypothesis on the next exam, I looked up every question, the ones that I didn’t know together with the ones that I did, or at least thought that I did. My score was dramatically better. I also learned a lot. The lesson for me was that “humility is far safer than hubris.”
I have had similar “wake up” experiences as an executive. On one occasion, having changed jobs, I brought all of my expertise as a managed care executive to a medical community whose culture was anything but “managed.” My knowledge about medical staffing needs was based on a decade of solid management experience with good results in an environment that turned out to be quite different from the one I entered. Needless to say, despite being a highly qualified expert in managing physician groups, I made a number of bad decisions that in retrospect could have easily been averted if only I had realized the limitations of my expertise. My new community differed from my old one in important ways that made my past experience, while not irrelevant, certainly not immediately transferable. Asking more questions, taking time to learn, questioning my own assumptions, and not assuming that I "knew” what the correct decisions were all would have been enormously helpful. My past experiences could still bring great value, but only when they were informed by present realities.
Sadly, sometimes experts do not see, or at least acknowledge, their shortcomings. One example stands out. During my residency in medicine I cared for a patient with a cardiac problem. The very distinguished attending cardiologist, who was an expert in cardiac auscultation, impressed me and my colleagues by hearing a cardiac murmur that we could not. The attending asserted the murmur defined the nature of the patient’s underlying cardiac problem. My team and I then ordered more definitive invasive tests that revealed fortunately that the patient did not have the problem we feared. When I apprised my attending of this good news, he solemnly remarked without irony “It is remarkable how much more sensitive and accurate the trained human ear is than modern technology.” I learned much medicine from this physician, who was an excellent teacher and a true gentlemen. I also learned that none of us, even the best of us, is immune from fooling ourselves by believing that we are more expert than we are.
Common definitions of experts generally describe an expert as an individual with a deep understanding of a field of knowledge or area of practice. “Experts” in an area have a great deal of experience — experience that is tempered by personal insights acquired over time. The depth of knowledge of an expert results from an aptitude to appreciate what they discover, see, or do with the things they experience. Expert musicians can often play a new piece after one hearing. Expert scientists seem to know instinctively how to ask questions that lead to new insights. Expert diagnosticians appear to rapidly distill complex issues into critical facts that permit them to make a diagnosis seemingly on sight. Speed in decision-making consequently is often used as a criteria for determining an expert.
However, we know intuitively that much more than speed is required to be an expert. Individuals who are described as “shooting from the hip” are usually not viewed as experts, despite their speed. The speed of true experts comes from the internalization of patterns and their nuances acquired over years. Their success as an expert is not just a chance event. Even experts can be seduced into believing they know more than they do. Rapid leaps to conclusions can lead to great errors that can threaten companies or human lives.
Donald Schon, in a classic work on professional thinking, The Reflective Practitioner,6 describes potential antidotes to the risk of being an expert. He describes the work of experts as “partners” in an endeavor rather than simply sources of knowledge. Asking questions, paying attention to detail, being honest about one’s assumptions and skeptical about one’s own conclusions, and being open to being mistaken are qualities which can mitigate “expert” mistakes. Simply working with others rather than alone is a highly useful strategy. Even an expert athlete benefits from a coach.
As a doctor, an executive, and a consultant, I enjoy being asked for advice. It makes me feel useful and good. I know all too well the human limitations of others are mine as well. As a result, I try to caution myself and those I advise that, even in areas where I have experience, my advice should be challenged, qualified, and adapted. I try to not think of myself as an expert, but rather as a learner. By not being an expert, I believe my “expertise” can even be more valuable to others.
Contact Bob at: [email protected]
References
- Kahneman, Daniel. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux, 2011.
- Gladwell, Malcolm. Outliers: The Story of Success. New York: Little, Brown and Company, 2008.
- Shermer, Michael. The Believing Brain: From Ghosts and Gods to Politics and Conspiracies - How We Construct Beliefs and Reinforce Them as Truths. New York Times Books, 2011.
- Taleb, Nassim Nicholas. Fooled by Randomness: the Hidden Role of Chance in the Markets and in Life. New York: Texere, 2001.
- McRaney, David. You Are Not So Smart: Why You Have Too Many Friends on Facebook, Why Your Memory Is Mostly Fiction. New York: Gotham Books/Penguin Group, 2011.
- Schon, Donald. The Reflective Practitioner. Basic Books, 1983.